Patient‐centered blood management

Abstract

BACKGROUND Transfusions are common in hospitalized patients but carry significant risk, with associated morbidity and mortality that increases with each unit of blood received. Clinical trials consistently support a conservative over a liberal approach to transfusion. Yet there remains wide variation in practice, and more than half of red cell transfusions may be inappropriate. Adopting a more comprehensive approach to the bleeding, coagulopathic, or anemic patient has the potential to improve patient care. METHODS We present a patient‐centered blood management (PBM) paradigm. The 4 guiding principles of effective PBM that we present include anemia management, coagulation optimization, blood conservation, and patient‐centered decision making. RESULTS PBM has the potential to decrease transfusion rates, decrease practice variation, and improve patient outcomes. CONCLUSION PBM's value proposition is highly aligned with that of hospital medicine. Hospitalists' dual role as front‐line care providers and quality improvement leaders make them the ideal candidates to develop, implement, and practice PBM. Journal of Hospital Medicine 2014;9:60–65. © 2013 Society of Hospital Medicine

Factors affecting patient‐reported outcomes after red blood cell transfusion in medical patients

“…The demand for blood products is increasing because of an aging population in affluent society and the advance in treatment like surgical procedures and chemotherapy . Patient blood management is advocated to reduce the need for allogeneic blood products transfusion . Randomized controlled trials suggested that restrictive red blood cell (RBC) transfusion using a hemoglobin (Hb) concentration of 70 to 80g/L as the transfusion trigger was not inferior to a more liberal strategy in terms of all‐cause mortality, cardiac events, length of hospital stay, and functional recovery .…”

“…2 Patient blood management is advocated to reduce the need for allogeneic blood products transfusion. 1,3,4 Randomized controlled trials suggested that restrictive red blood cell (RBC) transfusion using a hemoglobin (Hb) concentration of 70 to 80g/L as the transfusion trigger was not inferior to a more liberal strategy in terms of all-cause mortality, cardiac events, length of hospital stay, and functional recovery. 5,6 Restrictive transfusion is therefore recommended in various guidelines on transfusion practice.…”

In response to “Patient‐Centered Blood Management”

“…Dr. Horwitz appropriately notes that anemia of chronic disease may be better described as anemia of inflammation . We used the more traditional nomenclature for the sake of clarity to those readers who may not be familiar with the newer terminology.…”

“…Horwitz appropriately notes that anemia of chronic disease may be better described as anemia of inflammation. 1,2 We used the more traditional nomenclature for the sake of clarity to those readers who may not be familiar with the newer terminology. We do agree that there is often a role for hematology evaluation, but believe it should be based on the needs of the individual case and the needs of the organization.…”

In reference to “Patient‐Centered Blood Management”

“…There is one thing I would like to add to the flowsheet for management of preoperative anemia that Hohmuth et al have incorporated into their recent review titled “Patient‐Centered Blood Management.” Anemia of chronic disease, now called anemia of chronic inflammation, is still a diagnosis of exclusion, and I would recommend a hematology evaluation before the final step of starting somebody on erythropoietic agents.…”