Patient Blood Management
Patient Blood Management (PBM) is an evidence-based approach used by clinicians to optimize a patient’s current medical condition in order to ensure successful recovery. Its main focus is on preventing anemia and/or blood loss, but it also involves investigating and treating anemia when present.
PBM uses different medical and surgical techniques to avoid the use of blood transfusions if possible. It is important to remember that PBM does not mean that patients are never transfused. Despite all the techniques designed to avoid transfusions, when a transfusion is needed there are protocols and guidelines to help physicians make appropriate transfusion decisions.
Why is patient blood management important?
There are many reasons why we should practice PBM:
- It uses preventive techniques to conserve your own blood, eliminating the potential need for a blood transfusion.
- It reduces your exposure to potential risks associated with blood transfusions, especially complications and infections.
- It may help to decrease your hospital length of stay.
- More blood is available to treat patients with life-threatening conditions, after all, blood is an important resource greatly affected by supply and demand, and it is often life-saving in trauma and other critical care situations.
What PBM strategies help to ensure a successful recovery?
- Before Surgery: For patients undergoing elective procedures with a moderate to high risk for bleeding, a complete blood count (CBC) and iron studies are recommended at least 4 weeks prior to surgery. There are several medications that can be used to treat patients before surgery if they are deficient to improve red blood cell production or hemoglobin (Hgb) levels. These medications may include:
- Vitamin B12
- Folic acid
- Vitamin C
Patients are also instructed to stop specific medications that increase the risk of bleeding before surgery, such as ibuprofen, and aspirin. Your physician needs to know all the medications you take on a daily basis, including herbal supplements and vitamins.
- During Surgery: Surgeons and anesthesiologists take many precautions during surgery to conserve your blood. They use a variety of state of the art technologies and techniques, such as minimally invasive surgery, good surgical techniques, special instruments to cut and stop vessels from bleeding, the use of medications to decrease blood loss and even recovery of lost blood. These techniques are an important aspect of patient care.
- After Surgery: Avoiding unnecessary blood draws and using minimum volume test tubes reduces blood loss after surgery; medications that enhance the production of red blood cells can be added if necessary. Other blood recovery techniques are used during this period, depending of the kind of surgery performed. Blood recovery is the collection of blood lost during or after a procedure with the intent to return that blood to the patient.
We recommend that you and your family discuss the details of the strategies that can be used during your care in advance with your physician.
What is a blood transfusion?
A blood transfusion is a procedure in which a patient is given blood or blood components so that his or her body can function properly. The need for blood may be due to surgery, injury or a disease. A patient needing blood may be given whole blood or blood components — such as red cells, platelets or plasma — depending on his or her specific condition.
Why might my health care practitioner recommend a transfusion?
You may need to replace blood that is lost during surgery or an accident. Additionally, you may become anemic as a result of another illness or treatment.
Is it safe to receive a blood transfusion? What are the risks?
When used appropriately, blood can be lifesaving. However, as with any treatment or therapy, risks should be weighed with potential benefit. Receiving blood is safer today than it has ever been. Through stringent methods of selecting and testing blood donors, the risk of disease transmission through blood has been greatly minimized.
However, even the safest blood can cause your body to react in a way that impacts your health. The most common transfusion reactions are allergic reactions, which include symptoms such itching, hives, fever or chills. These mild to moderate reactions occur in less than 1 percent of patients who are transfused and are rarely life-threatening.
While exceedingly rare, more severe reactions can occur and may range from fever and nausea to kidney failure and death. Although the risk of any reaction is low, it is important that you talk with your doctor to better understand your care plan.
Should I donate blood before having surgery?
Donating one’s own blood before surgery is generally not advised, because this puts the individual at risk of anemia, in which there is a low level of circulating red cells within the person’s body. Anemia is the most common reason a patient is transfused. Patients should avoid anything that contributes to pre-surgery anemia because it can complicate the surgery and the patient’s recovery. An increasing number of surgeons use blood recovery techniques during surgery to return lost blood directly to the patient, thereby reducing the amount of transfused blood needed.
Is it good to ask someone I know to donate blood for me?
The safety of donated blood depends a great deal on the donor being truthful about any risky behaviors, in which he or she has engaged. Family and friends may feel enormous pressure to donate blood even if they know that they should not do so based on their health history. Although the donated blood from a family member or friend is tested like any other blood, individuals are generally not advised to ask others to donate blood for them, no matter how well they believe they know the person.
What should I do before a blood transfusion?
You should be sure to follow all of the instructions provided to you by your treating health care practitioner.
What questions should I ask my health care practitioner?
Some questions may include:
- Might I need a blood transfusion? If so, why?
- What steps will be taken before, during, and after my surgery to reduce the possibility of needing a transfusion?
- What policies have been implemented by the hospital to standardize the care of patients who might need a transfusion?
- Do I have any say in whether I get a transfusion?
Elsewhere on the Web
AABB: Blood FAQ
American Society of Hematology: Blood Banking & Donation
American Red Cross: Learn About Blood
MedlinePlus Medical Encyclopedia: Blood Typing
MedlinePlus Medical Encyclopedia: Transfusion Reaction
MedlinePlus Medical Encyclopedia: ABO Incompatibility
National Heart, Lung and Blood Institute: What is a blood transfusion?
AABB: Where to Donate Blood
This article was written by Nikky D’amour, RN, BSN, CEN, Director Patient Blood Management.
Getting Started in Patient Blood Management by James P. AuBuchon, MD, FCAP, FRCP(Edin); Kathleen Puca, MD, MT(ASCP)SBB, FCAP; Sunita Saxena, MD, MHA; Ira A. Shulman, MD, FCAP; and Jonathan H. Waters, MD (2011, AABB, 34 pages, ISBN 978-1-56395-828-1).
Waters, Jonathan H. Blood Management: Options for Better Patient Care, 1st Edition.
(©2014) AABB. Patient Blood Management. Available online at http://www.aabb.org/pbm/Pages/default.aspx. Accessed November 2015.