Patient Blood Management: Moving Above and Beyond the Optimal Use of Blood!

Abstract

Transfusion of blood components or products is among the most common procedures performed during a patient’s stay in the hospital. However, apart from being life-saving in exsanguination, blood transfusion is also associated with adverse events such as transfusion-transmitted infections, allergic reactions, transfusion-associated circulatory overload, transfusion-related acute lung injury, and transfusion-related immunomodulation with nosocomial infections and cancer recurrence. These potentially fatal complications have raised perennial concerns among healthcare professionals with regard to blood transfusion and patient outcomes. Thus, in the last few decades, the safety of the blood product has remained the key focus area for almost every stakeholder, whether end user or policy maker. Optimal use of blood is a globally recognized and recommended policy that ensures that the right amount and type of blood component is transfused to the right patient at the right time. Essentially, it focuses on improving the safety and effectiveness of the clinical transfusion process. However, with the evolving knowledge around transfusion science, increasing involvement of surgeons, anesthesiologists, and other specialists in transfusion offerings and proceedings, and the accumulating evidence on the fact that blood transfusion can, often, be more detrimental to a patient’s clinical status rather than benefiting it, has led to the endorsement and establishment of policy(ies) for optimal use of blood. Patient blood management (PBM), a concept coined and introduced almost two decades ago, encompasses, rather comprehensively, not just the policies and procedures of optimal use of blood and restricting transfusion to as minimum as possible but has a scope that spans much beyond that. PBM is driven and implemented through the three-pillar and nine-field matrix that incorporates the objectives of optimizing hematopoiesis, minimizing bleeding and blood loss, and harnessing and optimizing the physiological tolerance of anemia within the preoperative, intraoperative, and postoperative settings. PBM focuses on patient safety rather than product safety and, thus, ensures adopting a customized approach toward judicious and clinical use of the precious resource, blood. The principles and practices of PBM gained significant relevance and acceptability in the past few years, especially after the pandemic of COVID-19 when the World Health Organization issued a policy brief on its urgent implementation. Through this review article, we intend to establish not just the impact of PBM implementation towards improvement in patient outcomes but also the fact that the relevance and means of PBM extend far above and beyond just the optimal use of blood.