patient blood management (PBM)
An overall framework to address the risks of iron deficiency, anaemia, blood loss and coagulopathy
Intro
‘Patient blood management addresses the problems of anaemia, blood loss and coagulopathy. It is a patient-centred, systematic, evidence-based approach to improve patient outcomes by managing a patient’s own blood through diagnosis and etiology-specific treatment of anaemia and preserving the patient’s own blood by minimizing blood loss and bleeding, while promoting patient safety and empowerment. It reduces the utilization of health care resources as well as expenditures, transfusion dependency, and the risks and complications of transfusion.’ (WHO policy brief 2021)
This page offers a few key resources discussing the importance of patient blood management. It is important to have a good understanding of PBM as it has a very wide-ranging scope and a particular focus on patient-centred care.
‘The Urgent Need to Implement Patient Blood Management’ (WHO policy brief 2021)
Core elements of PBM
‘The use of every appropriate measure to protect and manage a patient’s own blood, in a manner that is tailored to the needs of the individual patient.’
‘The overarching aim of PBM is to improve patient outcomes, while saving health care resources and reducing costs'.’
Three Pillars to achieve PBM
Detection and management of anaemia and iron deficiency
Minimisation of blood loss and optimisiation of coagulation
Leveraging and opitmising the patient-specific physiological tolerance of anaemia
Other Themes include:
PBM has been developing over the last 40 years with ever increasing importance
Recognition that ‘our own blood is still the best thing to have in our veins’
PBM is a patient-centred approach to address iron deficiency, anaemia, blood loss & coagulopathy
Est. 2.9 billion people with anaemia worldwide
Key UK PBM resources
NHSBT PBM Website and Programme
Good summary site for important national reports / initiatives relating to transfusion
Includes Transfusion 2024 a report highlighting key priorities for clinical and laboratory transfusion practice over the 5 years from 2019, with four aims:
PBM
Laboratory safety
Information Technology
Research and Development
Some PBM-relevant trials/papers
Cochrane Review of transfusion thresholds
2021 update is expected, current review is from 2016
Use of a 70-80g/l threshold reduces proportion of patients exposed to transfusion by 43%
Restrictive transfusion does not negatively affect 30-day mortality or morbidity
REALITY 2021 - Acute MI. Restrictive thresholds non-inferior
MINT study (in progress as of 2021) - Acute MI. Powered to detect superiority of restrictive threshold
Tay et al 2020 - HSCT. Restrictive non-inferior with no difference in QoL measures
REDDS 2020 - MDS. Feasability study. QoL measures better in liberal arm. REDDS-2 in progress