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Definitions and Concepts in Patient Blood Management

Patient blood management (PBM) is an evidence-based approach to optimizing the care of patients who might need transfusion.

A focus on improved patient outcomes and economic and operational pressures are leading key industry thinkers to examine appropriate blood usage with new interest. Hospitals are eager to improve patient safety and clinical outcomes, while also reducing the need for allogeneic blood components. Patient blood management (PBM) programs can achieve these goals by reducing variation in transfusion practice and managing patients with nontransfusion—and, if appropriate, transfusion—treatment modalities.

Assessment and management of preoperative patients involves maximizing hemoglobin levels to prevent anemia and optimizing coagulation function to limit bleeding.

Starting with the primary care physician, the health-care team supporting medical and presurgical patients should focus efforts on determining whether there is a reason to suspect any medical conditions that might predispose the patient to transfusion.

Optimal patient care should involve a combination of different blood management strategies. An excellent example of this concept in practice is the dramatic synergy that can be obtained when multiple intraoperative techniques are employed.

Health-care providers with patients who wish to avoid transfusion during an invasive procedure can consider several strategies, including normovolemic hemodilution; intraoperative blood recovery and reinfusion; component sequestration; point-of-care testing; microsampling; deliberate hypotension; appropriate positioning; maintenance of normothermia; and use of improved surgical technique, topical hemostatics, and fibrin sealants.

Postoperative blood management techniques include: blood recovery and reinfusion, minimization of iatrogenic blood loss, optimization of erythropoiesis, prevention and management of anemia, prevention and arrest of bleeding, and even hyperbaric oxygen therapy.

During the postoperative period, anemia is of greatest concern in the intensive care unit (ICU). Members of the health-care team should be especially vigilant in looking for signs and symptoms of blood loss. Anticipation, rapid diagnosis, and control of hemorrhage should be undertaken as early as possible before the patient loses physiologic reserves. Blood that is shed from wound drainage can be recovered and reinfused.

The dual purpose of blood utilization review is to 1) minimize the inappropriate use of blood components and 2) promote transfusion of the right component at the right time to the right patient.

Blood utilization review touches all aspects of the transfusion process, including physician ordering, indications for transfusion, transfusion thresholds, patient identification, blood administration, monitoring for adverse effects, error reporting, the role of the Transfusion Committee or Transfusion Safety Officer, and quality improvement through physician education.