Supervisors info:
Γρ. Κουράκλης, Καθηγητής, Ιατρική, ΕΚΠΑ
Ωρ. Τραυλού, Καθηγήτρια , Ιατρική, ΕΚΠΑ
Ε.Γρουζή, Διευθύντρια ΕΣΥ, Αιματολόγος, "Αγιος Σάββας"
Summary:
Patient Blood Management (PBM) is an evidence-based, multidisciplinary approach to optimize the care particularly of those patients who are at risk of anemia and/or might need blood transfusions during hospitalization. PBM encompasses the pre-interventional optimization of red blood cell (RBC) mass, the minimization of blood loss, and the advancement of appropriate transfusion decision making. The imperative goal is to improve clinical outcome and patient safety.
The medical background of PBM is based on two major points: Firstly, anemia is associated with worse postoperative outcome, higher rates of infectious complications, prolonged hospitalization, and an increased likelihood of allogeneic blood transfusions. Secondly, increasing evidence suggests that over-transfusion of allogeneic blood products is associated with increased morbidity and mortality due to infectious, immunological, pulmonary, and thromboembolic complication. Especially worrisome is the substantial inter-institutional variability of transfusion practice, implicating high levels of insecurity regarding the indication for hemotherapy and potentially inappropriate usage. Furthermore, it appears odd that hemoglobin levels of critically ill patients on intensive care units show a convergence over time, irrespective of the admitting hemoglobin level, age, and comorbidities. PBM programs tackle these problems, using a multidisciplinary, multimodal, patient-focused approach to screen for, avoid and treat anemia as well as to minimize and standardize RBC transfusion with the ultimate goal of improving patient outcome.
The World Health Organization (WHO) has been officially urging member states to implement PBM since 2010 (WHA63.12). PBM programs have already been rolled out more or less successfully in most of Western Australia centers and in a few centers in Europe and the USA. Hence, there are vast regions around the world where PBM concepts still await profound and sustainable implementation. Acknowledging this, the European Commission recently announced a pilot program for the implementation of PBM in five European teaching hospitals. The implementation of a PBM program can be a very challenging task, because it involves the implementation of new standards of care, evidence-based knowledge and practice, as well as the refusal of the old dogma of “one-size fits all”. Experts who have implemented such programs successfully in the past, have outlined methods to influence the behavior of medical care providers and suggested an action plan for the wider implementation, evolution and evaluation of PBM programs (e.g. use of check list, bundle approach).
Keywords:
Anaemia, Transfusion, Perioperative bleeding, Ferrous, Goal-directed haemostatic therapy
