WHO/BTS is convening a two-day meeting of this forum in March 2011, to highlight the importance of effective blood management for patient health and safety in health-care systems, consider barriers to its implementation and identify factors causing variability in transfusion practices in different countries. Lessons learnt and strategies to address the major challenges faced by both developed and developing countries in managing blood use for quality patient care will also be discussed. This forum is, jointly organized by the Sharjah Blood Transfusion and Research Centre and co-sponsored by the Government of the United Arab Emirates, to be held on 14─15 March 2011 in Dubai, United Arab Emirates.
https://www.who.int/bloodsafety/events/gfbs_01_pbm_concept_paper.pdf?ua=1
https://eviteatransfusao-2021.dev2.server.diamondbybold.com/app/uploads/2021/05/Proposta-PDF-Dark.pdf
This PBM implementation guide was developed as a supporting tool for hospitals in the implementation of PBM at the operational level. It has taken inspiration from successfully implemented programmes in different parts of the world, recommending a well-recognised model for introducing change. It is acknowledged that alternative change management models could also be applied successfully. The guide focuses on how to implement the PBM concept in hospitals in a practical way, building on already recognised best practices (44-47). It does not aim to review the clinical evidence for PBM or to provide clinical PBM guidelines. A substantial list of publications that provide the rationale for PBM and that define good clinical practice supporting PBM is included at the end of this document. This guide is the result of the combined expertise of an international, multidisciplinary team of clinicians and PBM professionals and the collective experience gathered from a 30 month pilot programme for the implementation of PBM in five European teaching hospitals. The final goal is to support PBM as a sustainable standard of care across the EU. Given the multi-disciplinary and holistic approach required for PBM implementation, the guide is relevant for all medical professionals and organisations involved in caring for patients suffering from anaemia, blood loss and medical conditions that might require transfusion. It should stimulate hospital management to invest greater efforts in the evaluation and treatment of patients with low iron status prior to admission or surgery and should encourage transfusion stakeholders to take a fresh look at their professional fields and discover new opportunities for safely reducing the transfusion rate in their hospitals.
https://op.europa.eu/en/publication-detail/-/publication/93e1bbbf-1a8b-11e7-808e-01aa75ed71a1/language-en
Transfusions are one of the most overused treatments in modern medicine, at a cost of billions of dollars.
Transfusions are common procedures, at least in developed nations. In 2011, US doctors transfused 21 million units of blood and blood products; in the United Kingdom, the number was nearly 3 million. But although transfusions can be lifesaving, they are often unnecessary and are sometimes even harmful. “I think we were kind of brainwashed into thinking that blood saves lives, and the more you give the better,” says Steven Frank, an anaesthesiologist and
director of the blood-management programme at the Johns Hopkins Health System in Baltimore, Maryland. “We’ve gone 180 degrees, and now we think that less is more.”
Scientists are now recommending a more conservative approach to transfusions. But changing decades of established medical practice is not easy. Even when guidelines are clear, evidence suggests that clinicians often fail to follow them.
https://www.nature.com/news/polopoly_fs/1.17224!/menu/main/topColumns/topLeftColumn/pdf/520024a.pdf
Before major surgery, 30 to 40% of patients are anemic, an important consideration that is associated with increased erythrocyte transfusions, prolonged hospital length of stay, more frequent intensive care admissions, infections, and thromboembolic events, and mortality. Surgical bleeding contributes to anemia, increases transfusions, and independently increases mortality. In addition, transfusion of allogeneic blood products is associated with increased morbidity and mortality and increased costs, and allogeneic blood products are a limited resource. Therefore, as a pragmatic solution, the concept of Patient Blood Management was developed and published in its preliminary form, first in the anesthesia literature as an editorial in Anesthesiology in 2008. The authors hypothesized that “Patient Blood Management will decrease the use of allogeneic erythrocyte transfusion and its cost and adverse sequelae significantly.” Currently, 12 yr later, we can conclude this is indeed the case.
https://pubs.asahq.org/anesthesiology/article/133/1/212/109158/Patient-Blood-ManagementEffectiveness-and-Future
Patient Blood Management (PBM) is a multimodal, multidisciplinary approach adopted to limit the use and the need for allogeneic blood transfusion in all at-risk patients with the aim of improving their clinical outcomes. Although PBM usually refers to surgical patients, its clinical use has gradually evolved over the last few years and it now also refers to medical conditions. This review will critically analyse the current knowledge on the use of PBM programmes in surgical
and non-surgical patients.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6596379/pdf/blt-17-191.pdf
More than 30% of the world's population are anemic with serious economic consequences including reduced work capacity and other obstacles to national welfare and development. Red blood cell transfusion is the mainstay to correct anemia, but it is also 1 of the top 5 overused procedures. Patient blood management (PBM) is a proactive, patient-centered, and multidisciplinary approach to manage anemia, optimize hemostasis, minimize iatrogenic blood loss, and harness tolerance to anemia. Although the World Health Organization has endorsed PBM in 2010, many hospitals still seek guidance with the implementation of PBM in clinical routine. Given the use of proven change management principles, we propose simple, cost-effective measures enabling any hospital to reduce both anemia and red blood cell transfusions in surgical and medical patients. This article provides comprehensive bundles of PBM components encompassing 107 different PBM measures, divided into 6 bundle blocks acting as a working template to develop institutions' individual PBM practices for hospitals beginning a program or trying to improve an already existing program. A stepwise selection of the most feasible measures will facilitate the implementation of PBM. In this manner, PBM represents a new quality and safety standard.
https://www.sciencedirect.com/science/article/pii/S088779631630030X
Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health-system–wide PBM program. This study assesses program outcomes.
Implementation of a unique, jurisdiction-wide PBM program was associated with improved patient outcomes, reduced blood product utilization, and product-related cost savings.
https://onlinelibrary.wiley.com/doi/epdf/10.1111/trf.14006
Patient blood management programs are gaining popularity as quality improvement and patient safety initiatives, but methods for implementing such programs across multihospital health systems are not well understood. Having recently incorporated a patient blood management program across our health system using a clinical community approach, we describe our methods and results.
Implementing a health system-wide patient blood management program by using a clinical community approach substantially reduced blood utilization and blood acquisition costs.
https://pubs.asahq.org/anesthesiology/article/127/5/754/19141/Implementing-a-Health-System-wide-Patient-Blood
Os programas de Patient Blood Management (PBM), para além de visarem a melhoria dos resultados em saúde dos doentes, estão associados a um menor consumo de recursos e à redução de custos em Saúde.
Reconhecendo a importância desta temática e a elevada prevalência que a anemia apresenta no nosso país, a Associação Portuguesa para o Estudo da Anemia juntamente com a EXIGO Consultores, desenvolveram um modelo para avaliação do impacto da implementação de um programa nacional de PBM na saúde pública em Portugal.
A implementação de um PBM a nível nacional poderá representar um impacto substancial na redução da mortalidade intra-hospitalar e carga global das doenças associadas (DALY). Embora Portugal não seja um dos países Europeus com maior consumo de sangue per capita, um programa de PBM representará uma melhoria fundamental nos resultados em saúde relativos à utilização de transfusões e suas consequências na duração do internamento e na taxa de reinternamento.
Em suma, todos estes factores representam um elevado valor em termos de saúde pública, o que também implica um grande valor económico para o Serviço Nacional de Saúde, face à possibilidade de uma poupança substancial após um ano da implementação de um programa de PBM em Portugal.
Na eventualidade da implementação de um PBM em Portugal, a administração de ferro e a estratégia transfusional restritiva de concentrado eritrocitário seriam as intervenções de eleição de acordo com a opinião do grupo de peritos nacionais.
https://awgp.pt/wp-content/uploads/2019/09/20170222_PBM_AWGP_Relato%CC%81rio_vfinal.pdf
Given the recent emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the ensuing worldwide, widespread human-to-human transmission of the related Coronavirus Disease 2019 (COVID-19), the World Health Organization (WHO) has declared a pandemic status for this virus and the virus-related disease. As one of the corollaries, public health authorities and blood services are concerned with decreasing blood donations, ultimately resulting in blood shortages that will unquestionably lead to difficult and controversial transfusion rationing decisions by frontline health care providers. Considering that blood is a perishable commodity with a very short expiration time, as with past pandemics, blood services are being challenged to maintain their inventory during the current COVID-19 pandemics. On the other hand, analyses after past natural and man-made disasters have demonstrated either no change or a reduction in the demand for blood and its use.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173035/pdf/ane-publish_ahead_of_print-10.1213_ane.0000000000004844.pdf
For many physicians and clinicians and across many different specialties, blood transfusion is still considered the first line treatment when facing anaemia and/or blood loss. In the European Union (EU), more than 5 million patients are receiving around 24 million units of blood or blood components each year (Annual Summary of the Reporting of Serious Adverse Reactions and Events, 2015, European Commission). However, a large body of clinical evidence shows that in many clinical scenarios both anaemia and blood loss can be effectively treated with a series of evidence-based measures to better manage and preserve a patient’s own blood, rather than resorting to a donor’s blood, thus leading to a significant overall reduction of blood transfusions.
This is why over the last decade the focus in the EU, and elsewhere, has shifted from ensuring safety and quality of blood and blood components (product focused) towards a broader concept that takes a holistic, multi-disciplinary approach to caring for each patient’s haematopoietic system in a manner that aims to ensure the best possible outcome (patient-focused). This widely accepted approach is referred to as Patient Blood Management (PBM).
This guide for national authorities, and an equivalent one for hospitals, were delivered to the European Commission under that contract. They have no regulatory or legally–binding status but are intended as tools to support NAs and hospitals in EU Member States in establishing PBM as a standard to improve quality and safety of patient care. In order to ensure appropriate and optimal use of blood and blood components, transfusion decisions should always adhere to current evidence-based guidelines, and be taken after careful evaluation of a variety of patient-specific and patient-group-specific factors.
https://ec.europa.eu/health/sites/default/files/blood_tissues_organs/docs/2017_eupbm_authorities_en.pdf
Patient blood management (PBM) is a multidisciplinary concept focused on the management of anaemia, minimisation of iatrogenic blood loss and rational use of allogeneic blood products. The aims of this study were: (i) to analyse post-operative outcome in patients with liberal vs restrictive exposure to allogeneic blood products and (ii) to evaluate the cost-effectiveness of PBM in patients undergoing surgery.
Our results indicate that PBM may be associated with fewer adverse clinical outcomes compared to control management and may, thereby, be cost-effective.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343592/pdf/blt-17-016.pdf
More than 100 million units of blood are collected worldwide each year, yet the indication for red blood cell (RBC) transfusion and the optimal length of RBC storage prior to transfusion are uncertain.
To provide recommendations for the target hemoglobin level for RBC transfusion among hospitalized adult patients who are hemodynamically stable and the length of time RBCs should be stored prior to transfusion.
Research in RBC transfusion medicine has significantly advanced the science in recent years and provides high-quality evidence to inform guidelines. A restrictive transfusion threshold is safe in most clinical settings and the current blood banking practices of using standard-issue blood should be continued.
https://jamanetwork.com/journals/jama/article-abstract/2569055
Since the Transfusion Requirements in CriticalCare (TRICC) trial published in 1999 demon-strated equivalent or improved outcomes whenusing a restrictive versus a liberal transfusionthreshold in critically ill patients,1providers and institu-tions have sought to decrease utilization of allogeneicred blood cells by promoting restrictive transfusionpractices. Since that landmark trial, multiple other studiesin different p opulations, including patients undergoingcardiac surgery,2,3elderly patients undergoing hip replace-ment,4medical patients with gastrointestinal bleeds,5andpatients with traumatic brain injury,6have re-demonstrated the equivalence or superiority of restrictiveover liberal transfusion thresholds with regard to patientoutcomes. However, despite a growing body of evidencesupporting this practice, individuals and institutions havefound it surprisingly difficult to adhere to these guidelines.Nonetheless, there remain multiple motivations for reduc-ing superfluous transfusion; blood products are a finiteresource subject to shortage, there are numerous risksassociated with transfusion, and transfusion is an expen-sive endeavor from both direct (acquisition) and indirect(materials, labor , administration) costs.
https://onlinelibrary.wiley.com/doi/epdf/10.1111/trf.14083
A cirurgia eletiva é aquela que não se reveste das características de urgência ou emergência, ou seja, quando o doente não está sob o risco de vida, podendo ser efetuada em data programada, desde que essa data não comprometa a eficácia da intervenção.
O conceito de “gestão do sangue do doente” (Patient Blood Management: PBM) corresponde a uma estratégia global de boas práticas de transfusão, que permite a melhor utilização do sangue e dos seus componentes. O PBM é um exemplo de medicina baseada na evidência centrada no doente que, otimizando e conservando o próprio sangue do doente, visa melhorar os seus resultados em saúde.
Existem Recomendações Europeias, publicadas em março de 2017, dirigidas aos Hospitais e Autoridades Nacionais de Saúde, que recomendam o PBM como estratégia a implementar.
https://normas.dgs.min-saude.pt/wp-content/uploads/2019/10/gestao-do-sangue-do-doente-patient-blood-management-pbm-em-cirurgia-eletiva.pdf
Objective To develop a set of evidence-based recommendations for patient blood management (PBM) and for research.
Conclusions and Relevance The 2018 PBM International Consensus Conference defined the current status of the PBM evidence base for practice and research purposes and established 10 clinical recommendations and 12 research recommendations for preoperative anemia, RBC transfusion thresholds for adults, and implementation of PBM programs. The relative paucity of strong evidence to answer many of the PICO questions supports the need for additional research and an international consensus for accepted definitions and hemoglobin thresholds, as well as clinically meaningful end points for multicenter trials.
https://jamanetwork.com/journals/jama/article-abstract/2727453