Patient blood management: the global view

Shander, Aryeh; Isbister, James P.; Gombotz, Hans

doi:10.1111/trf.13529

Cited by 50 publications

(39 citation statements)

References 57 publications

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“…23 Its aim is to manage and preserve a patient's own blood by reducing the above-mentioned transfusion-related risk factors—anaemia, blood loss and red blood cell (RBC) transfusion—with the ultimate goal of improving the patient's outcome and safety 24. Therefore, identifying the underlying causes of the higher RBC transfusion rate in women and—as a consequence—enabling adequate and timely prevention and treatment might be of critical importance.…”

Section: Introductionmentioning

confidence: 99%

Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study

et al. 2016

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ObjectivesA post hoc gender comparison of transfusion-related modifiable risk factors among patients undergoing elective surgery.Settings23 Austrian centres randomly selected and stratified by region and level of care.ParticipantsWe consecutively enrolled in total 6530 patients (3465 women and 3065 men); 1491 underwent coronary artery bypass graft (CABG) surgery, 2570 primary unilateral total hip replacement (THR) and 2469 primary unilateral total knee replacement (TKR).Main outcome measuresPrimary outcome measures were the number of allogeneic and autologous red blood cell (RBC) units transfused (postoperative day 5 included) and differences in intraoperative and postoperative transfusion rate between men and women. Secondary outcomes included perioperative blood loss in transfused and non-transfused patients, volume of RBCs transfused, perioperative haemoglobin values and circulating red blood volume on postoperative day 5.ResultsIn all surgical groups, the transfusion rate was significantly higher in women than in men (CABG 81 vs 49%, THR 46 vs 24% and TKR 37 vs 23%). In transfused patients, the absolute blood loss was higher among men in all surgical categories while the relative blood loss was higher among women in the CABG group (52.8 vs 47.8%) but comparable in orthopaedic surgery. The relative RBC volume transfused was significantly higher among women in all categories (CABG 40.0 vs 22.3; TKR 25.2 vs 20.2; THR 26.4 vs 20.8%). On postoperative day 5, the relative haemoglobin values and the relative circulating RBC volume were higher in women in all surgical categories.ConclusionsThe higher transfusion rate and volume in women when compared with men in elective surgery can be explained by clinicians applying the same absolute transfusion thresholds irrespective of a patient's gender. This, together with the common use of a liberal transfusion strategy, leads to further overtransfusion in women.

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Section: Introductionmentioning

confidence: 99%

Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study

et al. 2016

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“…It puts the patient at the heart of decisions made about blood transfusion to ensure they receive the best treatment, and avoidable, inappropriate use of blood and blood components is reduced. It represents an international initiative in best practice for transfusion medicine (AABB, ; European Union, ; Shander et al, ,b).…”

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confidence: 99%

Patient blood management: how is implementation going?: A report comparing the 2015 survey with the 2013 survey of PBM in England

Sherliker

Pendry

Hockley

2018

Transfusion Medicine

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Improvements in 2015: Education/training in transfusion: 80-100% from 60-90% in 2013 Provision of information relating to consent for transfusion: 98% from 65% in 2013 (P = <0·001) The management of anaemia: elective general surgery management, 66% from 41% in 2013 (P = <0·001) Transfusion alternatives: Tranexamic use in surgery, 92% from 71% in 2013 (P = <0·001) Laboratory staff empowered to challenge transfusion requests, 95% from 65% in 2013 (P = 0·001) Further work required: Electronic systems to support requesting (e.g. mandatory recording of diagnosis: 47% from 48% in 2013 (P = 0·85), incorporation of standardised requesting codes: 27% from 33% in 2013 (P = 0·24) Appropriate use of components: in 2015, only 42% had a lower red cell transfusion thresholds policy in non-bleeding patients CONCLUSIONS: The results provided information to support the development of local and national work plans. It is hoped that the collaborative work across NHS Blood and Transplant (NHSBT), the National Blood Transfusion Committee (NBTC) and NHS Trusts will continue to drive the PBM agenda to support best practice in this field.

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“…In March 2017, the European Commission released guidelines for health authorities and hospitals with the goal to support PBM as a sustainable standard of care across the European Union . Nonetheless, PBM has been traditionally linked to hospital practices and perioperative anemia and reduces complications in surgical patients, when in fact transfusion is the result of ongoing and chronic processes developing over a long period of time in the vast majority of recipients …”

Section: Discussionmentioning

confidence: 99%

Red blood cell transfusion after a global strategy for early detection and treatment of iron deficiency anemia: three‐year results of a prospective observational study

Nieves¹,

Cobos²,

Gonzalez³

et al. 2018

Transfusion

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Patient blood management: the global view

Cited by 50 publications

References 57 publications

Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study

Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study

Patient blood management: how is implementation going?: A report comparing the 2015 survey with the 2013 survey of PBM in England

Red blood cell transfusion after a global strategy for early detection and treatment of iron deficiency anemia: three‐year results of a prospective observational study

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