Patient blood management programs: how to spread the word?

Abstract

Red blood cell (RBC) transfusions save lives and improve health; however, unnecessary transfusion practice exposes patients to immediate and long-term negative consequences. Indirect consequences of unnecessary transfusions are the reduced availability of RBC units for patients who are in need. Accumulating evidence shows that restricting RBC transfusions improves outcomes and current guidelines suggest limiting RBC transfusion to the minimum number of units required to relieve symptoms of anemia or to return the patient to a safe hemoglobin range (7–8 g/dl in stable, non-cardiac inpatients). Still, studies show that there is over-utilization of RBC transfusion, partly due to low level of knowledge of physicians regarding restrictive RBC transfusion policy across a broad range of professions and specialties. Patient blood management (PBM) programs have been developed to promote clear hospital transfusion guidelines, strive for optimization of patient hemoglobin and iron stores and, most importantly, improve education regarding restrictive RBC policy. Understanding what and where the gaps of knowledge are, as was done in the study by Dr. Koren and his colleagues, is an important step for developing effective PBM programs.

Demonstration of a U.S. nationwide reduction in transfusion in general surgery and a review of published transfusion reduction methodologies

“…Dominant strategies for transfusion reduction by descending order of the number of reports discussing the strategy included restrictive transfusion thresholds, management of preoperative anemia, perioperative interventions, educational programs, electronic clinical decision support, waste reduction, and audits of transfusion practices (Table 3 ). 2, 3, 6‐46 The remainder of the literature review is incorporated into the Discussion section below.…”

“…2017: Leahy, 24 Goodnough, 26 Meybohm, 25 Meybohm 37 2018: Revel‐Vilk, 28 Sadana, 29 Butcher, 30 Desai 31 …”

Improving Awareness about Patient Blood Management in Portugal: A Call for Action Arising from a Delphi Panel

“…Consensus level was achieved for only two of the 33 statements included in the panel (6%) -the lack of consensus on this topic reinforces the need for awareness-raising training programs in this area and the implementation of PBM programmes. 18,19 Moreover, a high agreement level was reached for 27 statements (82%). Even though these results signal convergent perspectives from a broad range of medical specialties, they equally highlight the lack of awareness regarding PBM principles -which would allow better postoperative outcomes and minimization of other interventions.…”

Quantitative assessment of the exposure–efficacy relationship of glucocerebrosidase using Markovian elements in Gaucher patients treated with enzyme replacement therapy

“…On the other hand, in low‐infiltration patients, there is a probability of 50% for complete remission of bone infiltration with intermediate‐dose (30 U/kg) as clinical practice reports. Due to data shortages, this study is unable to determine whether a high‐dose level (60 U/Kg) would lead to an improvement of more than one stage in the S‐MRI scale in patients with high bone infiltration (grade 3), as observed in clinical practice 62,63 …”

“…infiltration (grade 3), as observed in clinical practice. 62,63 The reduced sample size of GD patients and collected observations per individual may represent a limitation of the proposed population PK model as it could increase the risk of biased estimation of individual parameters. 64 The low incidence of GD partially explains the limited dataset, although it is also remarkable that the duration of the PK and efficacy study has allowed detection of a decrease over time of CL 1 .…”