Strategies to preempt and reduce the use of blood products

Abstract

Evidence-based patient blood management (PBM) is aimed at achieving better patient outcomes by relying on a patient's own blood rather than on donor blood. This review covers the rationale behind PBM, the treatment modalities involved and the drivers to adopt PBM as a new standard of care. Transfusion rates vary significantly between comparable countries; they also vary between centers for matched patients in standardized elective surgical interventions. Preoperative anemia, perioperative blood loss and liberal transfusion triggers are the main predictors for transfusion and pose risks to the patient. PBM is mitigating these risks by optimizing the patient's native red cell mass, minimizing blood loss, optimizing the physiological reserve of anemia and preempting transfusions. A growing number of studies show that transfusion is associated in a dose-dependent relationship with increased morbidity, mortality and hospital length of stay. Evidence suggests that this relationship is not merely associative but causal. Furthermore, the over-ageing population of the developed world leads to a growing gap between supply and demand of blood, the safety of donor blood remains unpredictable and the cost of transfusion is much higher than previously estimated. High transfusion variability, adverse transfusion outcomes, limited evidence for the benefit of transfusion particularly in elective patients and high cost of transfusion are challenging the traditional transfusion paradigm. National and state-wide initiatives are underway in Australia to broadly implement PBM and PBM programs as a new and cost-effective standard of care in the public health system.