Society for the advancement of blood management administrative and clinical standards for patient blood management programs. 4th edition (pediatric version)

Abstract

Summary Patient Blood Management is the timely application of evidence‐based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss to improve patient outcomes. Conceptually similar to a “bundle” strategy, it is designed to improve clinical care using comprehensive evidence‐based treatment strategies to manage patients with potential or ongoing critical bleeding, bleeding diathesis, critical anemia, and/ or a coagulopathy. Patient Blood Management includes multimodal strategies to screen, diagnose and properly treat anemia, coagulopathies and minimize bleeding, using goal‐directed therapy and leverages a patient's physiologic ability to adapt to anemia while definitive treatment is undertaken. Allogeneic blood component transfusion is one traditional therapeutic modality out of many for managing blood loss and anemia and, while it may be the best choice in certain situations, other effective and more appropriate options are available and should be used in conjunction or alone. Therefore, comprehensive Patient Blood Management is the new standard of care to prevent and manage anemia and optimize hemostasis and has been recommended by the World Health Organization, the American Society of Anesthesiologists, the European Society of Anaesthesiology and the Australian National Blood Authority. While there is a plethora of expert consensus and good practice guidelines published for blood component transfusion from multiple professional organizations and societies, there remains a need for more comprehensive and broader standards of patient medical management to proactively reduce the risk of exposure to allogeneic transfusions. In 2010, the Society for Advancement of Blood Management published the first comprehensive standards to address the administrative and clinical components of an effective, patient‐centered Patient Blood Management program. Recognizing the need to reduce inappropriate transfusions, some professional organizations have placed their emphasis on transfusion guidelines. In contrast, the focus of the Society for Advancement of Blood Management Standard is on the centrality of the patient and the full spectrum of therapeutic strategies needed to improve clinical outcomes in patients at risk for blood loss or anemia, thereby reducing avoidable transfusions as well. The Standards are meant not to replace, but to complement transfusion guidelines by more completely addressing the need for a multi‐modal clinical approach with the goal to improve patient outcomes. Compared to adult programs, Pediatric Patient Blood Management programs are currently not commonly accepted as standard of care for pediatric patients. This is partly due to the fact that, until recently, there was a paucity of robust evidence‐based literature and expert consensus guidelines on pediatric PBM. Managing pediatric bleeding and blood product transfusion presents a unique set of challenges. The main goal of transfusion is to correct or avoid imminent inadequate oxygen c...

Changes in Transfusion Practice in Children and Adolescents over Time

“…Although the PBM was primarily introduced in the area of adult care, its individual measures may also have had an impact on pediatrics. The treatment of iron deficiency anemia with iron preparations or the use of erythropoietin; reduction of the number and volume of blood samples; and adherence to physiological conditions of hemostasis (pH, calcium concentration and temperature) can be used, as well as the use of bedside coagulation diagnostics and targeted therapy in children [2,[13][14][15][16][17][18][19][20][21][22][23][24].…”

How do I manage long‐term blood component shortages in a hospital transfusion service?

“…Patient blood management guidelines and the most recent evidence for transfusion thresholds should be reviewed and implemented 4–8 . Several well controlled, randomized trials have demonstrated the safety of using a restrictive hemoglobin trigger (7‐8 g/dL) for patients in many settings in the hospital 9,10 .…”

Viscoelastic testing in pediatric patients

“…While some pediatric guidelines exist, the recommendations made for the use of VET are mainly based on the results of single-center retrospective studies and a handful of small randomized studies. 3,6 Although goal-directed bleeding management protocols based on VET are certainly beneficial in the pediatric population and have been favored by many authors, 3,5,7 Abbreviations: CFTs, clot formation times; CPB, cardiopulmonary bypass; CTs, clotting times; EXTEM, extrinsically activated test; FIBTEM, fibrin clot polymerization; INTEM, intrinsically activated test; MA, maximum clot amplitude; MCF, maximum clot firmness; ROTEM, rotational thrombelastometry; TEG, thrombelastography; VET, viscoelastic testing. clear thresholds and targets for neonates and pediatric patients have been poorly defined, and further studies are needed to develop and validate VET-based transfusion algorithms in neonates and children.…”