Patient blood management (PBM) is the timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin (Hb) concentration, optimize hemostasis, and minimize blood loss in an effort to improve patient outcome.
Anemia in the critically ill patients is often multifactorial and can be traced to one or a combination of iron deficiency, inflammatory responses, blunt response to endogenous erythropoietin, bleeding and aggressive diagnostic blood draws that are common in many intensive care units (ICUs).
The use of hemoglobin as the only “trigger” for red blood cell (RBC) transfusion should be avoided, and transfusion decisions should be made based on other parameters such as patient's volume status, evidence of shock, duration, and severity of anemia, and cardiopulmonary status of the patient.
The benefit of fresh frozen plasma (FFP) administration remains controversial and with the advent of more specific factor concentrates, its indications are on the decline.
Higher plasma (and platelet) to RBC ratios as part of “balanced” transfusion protocols during early resuscitation of trauma patients may be associated with better survival, but is still under investigation.
INTRODUCTION TO PATIENT BLOOD MANAGEMENT
Blood transfusion occurs in 1 of every 10 hospital admissions that includes an invasive procedure, and has been identified as one of the top 5 most frequently overused therapeutic procedures in the United States.1,2 Allogeneic blood transfusions have been associated with unfavorable patient outcomes, including morbidity and mortality3; and a significant percentage of transfusions to hospitalized patients have been identified to be inappropriate.4 These observations have led to proposals that exposure to blood transfusion should be regarded as quality indicators for clinical services.
Awareness of the risks, costs, and trends of blood inventory has stimulated interest in examining clinical implications of transfusions. Established in 2000, the Society for the Advancement of Blood Management (SABM, www.sabm.org) recognized the unmet need and developed the concept of PBM that changed the focus from transfusion of products (blood) to the patients' needs with the emphasis on improving patients' outcome. PBM is defined by SABM as “the timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss in an effort to improve patient outcome.”i The concept has been adopted by organizations globally, ranging from the National Blood Transfusion Committee in the United Kingdom, AABB in the United States, and National Blood Authority in Australia, to the World Health Organization (WHO) as put forward in Declaration 63.12 by the 63rd World Health Assembly.5,6
The PBM strategies in general have included management of anemia, minimization of blood loss, and increased focus on evidence-based transfusion practices, 3 strategies which form the pillars of PBM.7 It should be noted that despite many similarities, the “product-centered” concept of blood management—the predecessor to PBM—primarily addresses improving blood utilization which results in improved patient safety ...