scholarly journals Patient Blood Management: A Patient-Orientated Approach to Blood Replacement with the Goal of Reducing Anemia, Blood Loss and the Need for Blood Transfusion in Elective Surgery

2012 ◽  
Vol 39 (2) ◽  
pp. 67-72 ◽  
Author(s):  
Hans Gombotz
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Elective Surgery ◽  
Patient Blood Management ◽  
Blood Management ◽  
Blood Replacement

scholarly journals Blood Transfusion in Obstetric Cases

2020 ◽  
pp. 197-200
Author(s):  
Ali Sungkar ◽  
Raymond Surya
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Massive Transfusion ◽  
Patient Blood Management ◽  
Blood Products ◽  
Blood Management ◽  
Transfusion Therapy ◽  
Massive Transfusion Protocol ◽  
Life Threatening ◽  
Transfusion Protocol

Objective: To discuss about blood loss in an obstetric setting, the role of blood transfusion, and patient blood management.Methods: Literature review.Results: Severe anaemia with hemoglobin level less than 7 g/dL or late gestation (more than 34 weeks) and/ or significant symptoms of anaemia, the recommendation is giving only single unit transfusion followed by clinical reassessment for further transfusion. In postpartum hemorrhage (PPH), massive transfusion protocols are commonly used description as large volume of blood products over a brief period to a patient with uncontrolled or severe hemorrhage, transfusion more than 10 RBC units within 24 hours, transfusion more than 4 RBC units in 1 hour with anticipation of continued need for blood, replacement of more than 50% of total blood volume by blood products within 3 hours. All obstetric units have a clear-cut massive transfusion protocol for the initial management of life-threatening PPH, considering early transfusion therapy with RBCs and FFP.Conclusion: Patient blood management aims to maintain hemoglobin concentration, optimize haemostasis, and minimize blood loss in effort to improve patient outcomes. Massive transfusion protocol in management of life-threatening should depend on each obstetric unit.Keywords: blood transfusion, obstetric cases, patient blood management.   Abstrak Tujuan: Untuk mendiskusikan tentang hilang darah dalam obstetric, peran transfusi darah, dan patient blood management.Metode: Kajian pustaka.Hasil: Anemia berat dengan nilai hemoglobin kurang dari 7 g/dL atau kehamilan lanjut (lebih dari 34 minggu) dan/ atau gejala nyata anemia, rekomendasi ialah memberikan satu unit transfusi diikuti dengan penilainan klinis untuk transfusi lebih lanjut. Pada perdarahan postpartum, protokol transfusi massif umum digambarkan sebagai volume darah yang dibutuhkan jumlah banyak dalam periode singkat, transfusi lebih dari 10 sel darah merah dalam 24 jam atau lebih dari 1 jam, penggantian lebih dari 50% total volume darah dalam 3 jam. Seluruh unit obstetric memiliki protokol transfusi massif yang jelas untuk taalaksana awal perdarahan postpartum dengan mempertimbangkan transfusi awal untuk komponen sel darah merah dan FFP.Kesimpulan: Patient blood management bertujuan untuk menjaga konsentrasi hemoglobin, optimalisasi hemostasis, dan minimalisasi hilang darah untuk meningkatkan luaran pasien. Protokol transfusi masfi dalam tatalaksana yang mengancam nyawa sangat bergantung pada setiap unit obstetrik.Kata kunci: kasus obstetri, patient blood management, transfusi darah  

scholarly journals Development of Multivariable Models to Predict and Benchmark Transfusion in Elective Surgery Supporting Patient Blood Management

2017 ◽  
Vol 08 (02) ◽  
pp. 617-631 ◽  
Author(s):  
Dieter Hayn ◽  
Karl Kreiner ◽  
Hubert Ebner ◽  
Peter Kastner ◽  
Nada Breznik ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Red Blood Cells ◽  
Predictive Modeling ◽  
Blood Cells ◽  
Elective Surgery ◽  
Patient Blood Management ◽  
Learning Tools ◽  
Blood Management ◽  
Clinical Scenarios ◽  
Multivariable Models

SummaryBackground: Blood transfusion is a highly prevalent procedure in hospitalized patients and in some clinical scenarios it has lifesaving potential. However, in most cases transfusion is administered to hemodynamically stable patients with no benefit, but increased odds of adverse patient outcomes and substantial direct and indirect cost. Therefore, the concept of Patient Blood Management has increasingly gained importance to pre-empt and reduce transfusion and to identify the optimal transfusion volume for an individual patient when transfusion is indicated.Objectives: It was our aim to describe, how predictive modeling and machine learning tools applied on pre-operative data can be used to predict the amount of red blood cells to be transfused during surgery and to prospectively optimize blood ordering schedules. In addition, the data derived from the predictive models should be used to benchmark different hospitals concerning their blood transfusion patterns.Methods: 6,530 case records obtained for elective surgeries from 16 centers taking part in two studies conducted in 2004–2005 and 2009–2010 were analyzed. Transfused red blood cell volume was predicted using random forests. Separate models were trained for overall data, for each center and for each of the two studies. Important characteristics of different models were compared with one another.Results: Our results indicate that predictive modeling applied prior surgery can predict the transfused volume of red blood cells more accurately (correlation coefficient cc = 0.61) than state of the art algorithms (cc = 0.39). We found significantly different patterns of feature importance a) in different hospitals and b) between study 1 and study 2.Conclusion: We conclude that predictive modeling can be used to benchmark the importance of different features on the models derived with data from different hospitals. This might help to optimize crucial processes in a specific hospital, even in other scenarios beyond Patient Blood Management.Citation: Hayn D, Kreiner K, Ebner H, Kastner P, Breznik N, Rzepka A, Hofmann A, Gombotz H, Schreier G. Development of multivariable models to predict and benchmark transfusion in elective surgery supporting patient blood management. Appl Clin Inform 2017; 8: 617–631 https://doi.org/10.4338/ACI-2016-11-RA-0195

scholarly journals Avoidable Blood Loss in Critical Care and Patient Blood Management: Scoping Review of Diagnostic Blood Loss

2022 ◽  
Vol 11 (2) ◽  
pp. 320
Author(s):  
Philipp Helmer ◽  
Sebastian Hottenrott ◽  
Andreas Steinisch ◽  
Daniel Röder ◽  
Jörg Schubert ◽  
...  
Keyword(s):  
Intensive Care ◽  
Blood Loss ◽  
Blood Volume ◽  
Scoping Review ◽  
Relevant Information ◽  
Blood Collection ◽  
Patient Blood Management ◽  
Blood Management ◽  
Intensive Care Patients ◽  
Blood Collection Tubes

Background: Anemia remains one of the most common comorbidities in intensive care patients worldwide. The cause of anemia is often multifactorial and triggered by underlying disease, comorbidities, and iatrogenic factors, such as diagnostic phlebotomies. As anemia is associated with a worse outcome, especially in intensive care patients, unnecessary iatrogenic blood loss must be avoided. Therefore, this scoping review addresses the amount of blood loss during routine phlebotomies in adult (>17 years) intensive care patients and whether there are factors that need to be improved in terms of patient blood management (PBM). Methods: A systematic search of the Medline Database via PubMed was conducted according to PRISMA guidelines. The reported daily blood volume for diagnostics and other relevant information from eligible studies were charted. Results: A total of 2167 studies were identified in our search, of which 38 studies met the inclusion criteria (9 interventional studies and 29 observational studies). The majority of the studies were conducted in the US (37%) and Canada (13%). An increasing interest to reduce iatrogenic blood loss has been observed since 2015. Phlebotomized blood volume per patient per day was up to 377 mL. All interventional trials showed that the use of pediatric-sized blood collection tubes can significantly reduce the daily amount of blood drawn. Conclusion: Iatrogenic blood loss for diagnostic purposes contributes significantly to the development and exacerbation of hospital-acquired anemia. Therefore, a comprehensive PBM in intensive care is urgently needed to reduce avoidable blood loss, including blood-sparing techniques, regular advanced training, and small-volume blood collection tubes.

scholarly journals A SARS-CoV-2-pandémia hatása a vérkészítmény-felhasználásra a Pécsi Tudományegyetemen

2021 ◽  
Vol 162 (43) ◽  
pp. 1717-1723
Author(s):  
Sándor Pál ◽  
Barbara Réger ◽  
Tamás Kiss ◽  
Hussain Alizadeh ◽  
András Vereczkei ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Blood Product ◽  
Patient Blood Management ◽  
Blood Products ◽  
Blood Management ◽  
Number Of Patients ◽  
Willingness To Donate ◽  
The Impact

Összefoglaló. Bevezetés: A COVID–19-világjárvány betegellátásra gyakorolt hatása hazánkban is jelentős. A vérellátást nehezítette a járványügyi intézkedések következményeként a véradási események elmaradása, a csökkent véradási hajlandóság, továbbá a nehezen megítélhető vérkészítményigény . A „Patient Blood Management” irányelveinek az orvosi gyakorlatban történő egyre szélesebb körű alkalmazása elősegíti az optimális vérkészítmény-felhasználást a transzfúziók lehetőség szerinti elkerülésével. Célkitűzés és módszer: Vizsgálatunk célja a Pécsi Tudományegyetem Klinikai Központjának Janus Pannonius Klinikai Tömbjében a vérkészítmény-felhasználás változásainak felmérése volt a 2020. év első öt hónapjában. Eredmények: A járványügyi intézkedéseket követő időszakban szignifikánsan csökkent a hospitalizált betegeknek (34,08%), a transzfúziót igénylő betegeknek (39,69%) és a felhasznált vörösvérsejt-készítményeknek (46,41%) a száma, valamint az egy betegre jutó felhasznált vörösvérsejt-koncentrátum átlaga (2,61-ről 1,97-re) is. Közel 30%-os arányban csökkent a felhasznált friss fagyasztott plazma egységeinek és a thrombocytakoncentrátumoknak a száma is. Következtetés: A szigorú korlátozások életbe léptetését követően a nehézségek ellenére sikerült elegendő mennyiségű vérkészítményt biztosítani a betegeknek. Az Országos Vérellátó Szolgálat Pécsi Regionális Vérellátó Központja munkatársainak és a klinikusok erőfeszítéseinek köszönhetően a vérkészítményigény és -kínálat között új egyensúly alakult ki, mely megfelelő ellátást biztosított a feltétlenül szükséges transzfúziók kivitelezéséhez. Orv Hetil. 2021; 162(43): 1717–1723. Summary. Introduction: The impact of COVID–19 pandemic on patient care is pronounced also in Hungary. Blood supply was hindered by the reduction of public blood donation events, the reduced willingness to donate, and the difficult predictability of blood product demand as a result of the epidemiological regulations. The wider application of Patient Blood Management guidelines in the medical practice will promote optimal blood product utilization by avoiding transfusions where possible. Objective and method: The aim of our study was to assess the changes in the usage of blood products in the first five months of 2020 at the Clinical Center of the University of Pécs, Janus Pannonius Clinical Building. Results: In the period following the epidemiological measures, we found reduction in the number of hospitalized patients (34.08%), in the number of patients requiring transfusion (39.69%) and in the number of red blood cell products used (46.41%). The number of transfused red blood cell concentrates per patient was also significantly reduced (from 2.61 to 1.97) in this period. The number of transfused fresh frozen plasma units and platelet concentrates also decreased by approximately 30%. Conclusion: After the implementation of the strict restrictions, despite the difficulties, it was possible to provide patients with sufficient blood products. Due to the efforts of both the Regional Blood Transfusion Center of Pécs of the Hungarian National Blood Transfusion Service and of the clinicians, a new balance was established between the demand and the supply of blood products, which provided adequate care for the necessary transfusions. Orv Hetil. 2021; 162(43): 1717–1723.

Path to Action – Closing the Gap to Make Patient Blood Management the New Norm(al) as Viewed by Implementors in Diverse Countries

2020 ◽  
Author(s):  
Axel Hofmann ◽  
Donat R. Spahn ◽  
Anke-Peggy Holtorf
Keyword(s):  
Blood Loss ◽  
Research Training ◽  
Multidisciplinary Care ◽  
Adverse Outcomes ◽  
National Standard ◽  
Care Process ◽  
Patient Blood Management ◽  
Blood Management ◽  
Structured Interviews ◽  
Implementation Framework

Abstract Background: Patient Blood Management (PBM) is an evidence-based approach in surgery and emergency care which aims to minimize the risk for blood loss and the need for blood replacement for each patient through a coordinated multidisciplinary care process before, during, and after surgery. In combination with blood loss, anemia is the main driver for transfusion and an independent risk factor for adverse outcomes including morbidity and mortality. Hence, identifying and correcting anemia as well as minimizing blood loss are important pillars of PBM. Evidence demonstrates that PBM significantly improves outcomes and safety while reducing cost by macroeconomic magnitudes. Despite its huge potential to improve healthcare systems, PBM is not yet adopted broadly. The aim of this study is to analyze the collective experiences of a diverse group of PBM implementors across countries reflecting different healthcare contexts and to use these experiences to develop a guidance for initiating and orchestrating PBM implementation for stakeholders from diverse professional backgrounds.Methods: Semi-structured interviews were conducted with 1-4 PBM implementors from 12 countries in Asia, Latin America, Australia, Central and Eastern Europe, the Middle East, and Africa. Responses reflecting the drivers, barriers, measures, and stakeholders regarding the implementation of PBM were summarized per country, and key observations extracted. By clustering the levels of intervention for PBM implementation, a PBM implementation framework was created and populated.Results: A set of PBM implementation measures were extracted from the interviews with the implementors. Most of these measures relate to one of six levels of implementation including government, healthcare providers, funding, research, training/education, and patients/public. Essential cross-level measures are multi-stakeholder communication and collaboration.Conclusion: This implementation framework helps to decompose the complexity of PBM implementation into concrete measures on each implementation level. It provides guidance for diverse stakeholders to independently initiate and develop strategies to make PBM a national standard of care, thus closing current practice gaps and matching this unmet public health need.

Patient blood management strategies in cardiac surgery

2021 ◽  
pp. 217-224
Author(s):  
Aryeh Shander ◽  
Victor A. Ferraris
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Management Strategies ◽  
Patient Blood Management ◽  
Blood Management ◽  
Cardiac Surgery Patient ◽  
Surgery Patient ◽  
Surgery Management

This chapter discusses patient blood management strategies in cardiac surgery, including sections on the burden of anaemia in cardiac surgery, blood transfusion in cardiac surgery, patient blood management in cardiac surgery (management of anaemia, optimization of haemostasis, autotransfusion techniques, and other supportive measures), and outcomes of patient blood management programmes.

Anaemia and blood transfusion: incorporating patient blood management

2019 ◽  
Vol 37 (8) ◽  
pp. 424-430
Author(s):  
Sean R. Bennett ◽  
Mahasen Al Harbi
Keyword(s):  
Blood Transfusion ◽  
Patient Blood Management ◽  
Blood Management

scholarly journals Patient Blood Management: Implementation of a Preoperative Anemia Clinic for Elective Orthopedic Surgical Patients

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2547-2547
Author(s):  
Paul Letendre ◽  
Emily Coberly ◽  
Katie Dettenwanger ◽  
Kan Huang
Keyword(s):  
Patient Safety ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Elective Surgery ◽  
Surgical Patients ◽  
Patient Blood Management ◽  
Blood Management ◽  
Preoperative Anemia ◽  
Red Blood Cell Transfusions ◽  
Work Up

Abstract Background: Patient blood management (PBM) programs aim to implement best practices and encourage blood stewardship. Judicious use of red blood cell transfusions improves patient safety, decreases hospital length of stay (LOS) and reduces cost. A 2010 World Health Organization statement asserted "…before surgery every reasonable measure should be taken to optimize the patient's own blood volume, minimize the patient's blood loss and to harness and optimize physiological tolerance of anemia…". A comprehensive PBM program includes a preoperative anemia clinic to facilitate these goals. At our institution, 21% of surgical patients are anemic prior to their elective surgery and these patients consume approximately 67% of our transfused operating room blood. Our aim was to reduce red blood cell transfusions in elective orthopedic surgical patients by 25% and decrease hospital LOS through the implementation of a preoperative anemia clinic. Methods: After enlisting the support of hospital leadership, a preoperative anemia clinic referral/consult order was added the electronic medical record. Appropriate patients for referral were undergoing elective orthopedic surgery and had anemia defined as a Hgb <11.0 g/dl. Additional non-anemic patients with extenuating circumstances such as religious objection to transfusion were also referred. Every effort was made to see patients at least 2 weeks prior to the date of scheduled surgery or within 48 hours if the referral was not placed that far in advance. Work-up of anemia was individualized based on a patient's laboratory abnormality and medical profile. Interventions were targeted at treating the underlying cause of anemia and included but were not limited to parenteral iron, erythropoietin receptor agonists, and vitamin B12 injections. The primary measures assessed were the average LOS from day of surgery to discharge and the number of red blood cell units transfused during that stay. Findings: Early data since implementing our preoperative anemia clinic has demonstrated a reduction in LOS from 5.5 days for anemic patients undergoing elective surgery without a referral versus 3.5 days for those with a referral. A relative decrease in LOS of 36%. Reductions in hospital LOS were observed across the spectrum of all elective surgical procedures. The overall red blood cell transfusion rate in patients without referral versus with referral was 1.5% and 1.2% respectively; and of those requiring a transfusion, the mean red blood cell units transfused in the perioperative period was 2.31 units versus 1.19 units, resulting in a relative reduction of 48%. Additionally, 2 patients were diagnosed with a gastric ulcer and 2 patients with multiple myeloma during work-up and referred appropriately for treatment. Discussion: Expansion of the PBM program at our institution to include a preoperative anemia clinic has led to significant reductions in both red blood cell transfusions and hospital LOS in elective orthopedic surgical patients. Early results indicate a near doubling of our goal of a 25% reduction in red blood cells transfused. This has positively impacted our patients and led to both direct and indirect financial savings at our institution. Given the initial success, we hope to expand our preoperative anemia clinic to include all surgical specialties and streamline workflow. To facilitate growth additional staffing will be required. We have created patient education videos about the benefits of correcting their anemia prior to an elective surgery and hope to further engage primary care practitioners to refer patients earlier in their surgical evaluation. We conclude that the creation of a preoperative anemia clinic at our institution is a valuable resource and has led to a decreased use of red blood cell transfusions, a decreased average hospital LOS, improved patient safety and considerable financial savings. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

scholarly journals Reticulocyte and Erythrocyte Hemoglobin Parameters for Iron Deficiency and Anemia Diagnostics in Patient Blood Management. A Narrative Review

2021 ◽  
Vol 10 (18) ◽  
pp. 4250
Author(s):  
Christian Hoenemann ◽  
Norbert Ostendorf ◽  
Alexander Zarbock ◽  
Dietrich Doll ◽  
Olaf Hagemann ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Blood Loss ◽  
Blood Cells ◽  
Blood Count ◽  
Iron Status ◽  
Full Blood Count ◽  
Patient Blood Management ◽  
Acute Blood Loss ◽  
Blood Management ◽  
Main Factors

Anemia, iron deficiency and other hematinic deficiencies are a major cause of perioperative transfusion needs and are associated with increased morbidity and mortality. Anemia can be caused either by decreased production of hemoglobin or red blood cells or by increased consumption and blood loss. Decreased production can involve anything from erythropoietin or vitamin B12 insufficiency to absolute or functional lack of iron. Thus, to achieve the goal of patient blood management, anemia must be addressed by addressing its causes. The traditional parameters to diagnose anemia, despite offering elaborate options, are not ideally suited to giving a simple overview of the causes of anemia, e.g., iron status for erythropoiesis, especially during the acute phase of inflammation, acute blood loss or iron deficiency. Reticulocyte hemoglobin can thus help to uncover the cause of the anemia and to identify the main factors inhibiting erythropoiesis. Regardless of the cause of anemia, reticulocyte hemoglobin can also quickly track the success of therapy and, together with the regular full blood count it is measured alongside, help in clearing the patient for surgery.

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