Transfusion Medicine: Time for a Change: Patient Blood Management and the Ontario ONTraC Program

Abstract

Despite increasing recognition of the potential adverse effects of blood transfusion there is evidence that the procedure is over-utilized and often inappropriately and unnecessarily administered. Patient Blood Management (PBM) is a recent world-wide initiative to optimize transfusion therapy by employing preoperative and perioperative maneuvers and alternatives to avoid unnecessary blood transfusion. These approaches are, however, not restricted to the surgical setting, but may be applied whenever transfusion is contemplated. A key component of PBM is the appropriate management of anemia, a prime determinant of transfusion. Another is tolerance of anemia through the use of restrictive transfusion thresholds for transfusion and of a single unit at a time policy. Among a number of options at surgery, antifibrinolytics have proven effective at reducing blood loss and transfusion. Burgeoning literature demonstrates that PBM (also known as Blood Conservation or as 'Bloodless Medicine/Surgery') is costeffective while improving patient outcomes and conserving the blood supply. Data from the ONTraC program in Ontario are described herein to illustrate the effectiveness of PBM approaches.

L’importance de l’hémoglobine : gestion périopératoire du sang pour les patients en oncologie

“…De plus en plus de recherches montrent que les transfusions sanguines peuvent accroître la morbidité et la mortalité des patients, allonger la durée de l'hospitalisation, gonfler les coûts et entraîner des pénuries de sang. Devant ces constats, les pratiques de GSP cherchent à réduire le besoin de transfusions sanguines de trois manières : en traitant l'anémie avant l'opération, en réduisant le plus possible les pertes de sang pendant l'opération et en favorisant une utilisation adéquate du sang en postopératoire (Althoff et al, 2019;Freedman, 2016).…”

“…Il existe différentes techniques chirurgicales pour réduire les pertes sanguines périopératoires chez les patients en oncologie, notamment les analyses de coagulation hors laboratoire, les agents hémostatiques topiques, les médicaments hémostatiques et la récupération du sang périopératoire (Freedman, 2016). Les médicaments et techniques d'anesthésie peuvent également influer sur la perte de sang périopératoire.…”

Patient blood management and the importance of the Transfusion Practitioner role to embed this into practice

“…Where TP roles are established, they are widely acknowledged as a critical part of the transfusion/PBM process in the healthcare setting. Literature is slowly emerging that supports the value of the role and the benefit it brings (Bielby et al, 2011;Miller et al, 2015;Freedman, 2016).…”

“…As PBM is becoming more established, there is an increasing number of peer-reviewed literature becoming available about the TP and their role in PBM (Puca & Johnson, 2013, Miller et al, 2015, Freedman, 2016, Moss, December 2016. As Freedman also acknowledged, it is important for those in the role to document and share their experiences, challenges and successes to allow others to learn from these.…”

“…The authors describe below various aspects of PBM and share some of the strategies from the UK and Australian perspectives. Freedman (2016) describes blood transfusion as one of the five most overused procedures, with much of it being inappropriate use and very variable in and between organisations.…”