The importance of patient blood management for patients, providers and the public
Patient blood management (PBM) is a systematic and multidisciplinary approach to provide higher-quality care to patients who have traditionally received blood transfusions as a part of their therapy. It is an alternative approach to the conventional transfusion approach which is centered around optimizing transfusion thresholds and triggers. In contrast, PBM adopts a more holistic approach by keeping the patient at the center and using various strategies and interventions to minimize the need for transfusions and optimize patient outcomes. Various studies have found that compared to the conventional approach, implementing PBM may be associated with improved patient outcomes and better quality of life. Blood transfusions involve a limited resource, and PBM ensures that blood is used responsibly and ethically. Key elements of PBM include preventing blood component transfusions by diagnosing and treating anemia or other nutritional deficiencies before transfusion seems unavoidable, as well as educating health care providers when transfusions may not be necessary. Despite high-quality studies and abundant literature attesting to its benefits, it has not become firmly established as an essential part of medical care. One concrete example is that the current care model allows many patients with iron deficiency anemia to be scheduled for elective surgery and receive intraoperative or postoperative blood transfusions that could have been avoided if the patient started surgery with higher hemoglobin levels and intraoperative blood-saving methods had been used. The requirement of a multidisciplinary approach from different stakeholders has likely hindered the more widespread adoption of PBM. Although the individual stakeholder can recognize the soundness of the idea of PBM, implementation seems overwhelming. By explicitly focusing on the roles of the major stakeholders in the blood component transfusion enterprise; patients, bedside health care providers, blood banking and transfusion specialists, health care administrators, and society at large, the authors hope that the importance of PBM will become a more desirable and accomplishable goal. By understanding their roles in the overall care of the patient, a framework can be established to make PBM a more realistic undertaking for all stakeholders.
