science

Patient blood management

Patient blood management is a science topic covered in the lgStudy science library. This page brings together a partial reference excerpt, illustrations, worked examples, real-world applications and a short study plan, so you can understand Patient blood management rather than just read about it. In short: Patient Blood Management (PBM) is a set of medical practices designed to optimise the care of patients who might need a blood transfusion. Patient blood management programs use an organized framework to improve blood health, thus increasing patient safety and quality of life, reducing costs, and improving clinical outcomes.

Key takeaways

Patient blood management belongs to science; place it in that map before memorising details.
Learn the definition first, then one example that makes the definition concrete.
Connect Patient blood management to a quantity you can measure, compute or draw — that is where exam questions come from.
Reproduce the core statement of Patient blood management from memory before moving on to harder problems.

Reference excerpt

Patient Blood Management (PBM) is a set of medical practices designed to optimise the care of patients who might need a blood transfusion. Patient blood management programs use an organized framework to improve blood health, thus increasing patient safety and quality of life, reducing costs, and improving clinical outcomes. Some strategies to accomplish this include ensuring that anemia is treated prior to a surgical operation, using surgical techniques that limit blood loss, and returning blood lost during surgery to the patient via intraoperative blood salvage. Patient blood management represents an international initiative in best practice for patient centered care that is supported by the World Health Organization (WHO). Patient blood management is about enhancing a patient's own blood health by managing anemia, optimizing coagulation, and using blood conservation strategies. Examples of how to implement PBM are available from Australia, the UK, and the US.

History The term "Patient Blood Management" was first used in 2005 by Professor James Isbister, an Australian hematologist, who believed that the focus of transfusion medicine should shift from the blood component to the patient. During a session of the World Health Assembly in 2010, the resolution WHA63.12 was adopted, which included recommendations on the safety and availability of blood components. PBM initially consisted of pharmacological and non-pharmacological techniques, to be adopted before, during, and after surgery, to prevent the patient from arriving in the operating room in a condition of anemia.

Medical uses Patient Blood Management is an approach that can be implemented in hospital settings for taking care of people who require blood transfusions. PBM includes techniques that may help ensure each person receiving a blood transfusion receives optimal treatment for their condition and also ensures that the blood supply (bank of donated blood) is maintained to ensure that all people who require blood components in the hospital have them available at the time that they would benefit from them. Patient Blood Management can be beneficial in surgical settings and in non-surgical settings with the goal of reducing the risk of needing a blood transfusion and improving the outcome for those who require a blood transfusion.

Technique Three pillars of patient blood management:

Detect and treat anemia. Prevent or minimize blood loss. Enhance patient's physiological reserve to tolerate anemia. The cornerstone of patient blood management is a multidisciplinary approach, involving family physicians, nurses, anesthetists, surgeons, Transfusion Practitioners, hematologists, and hematology and blood transfusion laboratory staff. Part of PBM is avoiding unnecessary treatments and procedures, and some of the PBM recommendations from around the world have been incorporated in to the "Choosing Wisely" campaigns that exist in Australia, Canada, the UK, and the US. A challenge lies in identifying those patients who are at risk of complications of severe anemia (ischemia) and transfusing them, without exposing other patients to unwarranted risks of inappropriate transfusions.

Surgical settings Patient blood management in the perioperative setting can be achieved by means of a variety of techniques and strategies. First, ensuring that the patient enters the operating room with a sufficient hematocrit level is essential. Preoperative anemia has been documented to range from 5% in female geriatric hip fracture patients to over 75% in colon cancer patients. Patients who are anemic prior to surgery often require more transfusions. Erythropoietin and iron therapy can be considered in cases of anemia. Accordingly, patients should be screened for anemia at least 30 days prior to an elective surgical procedure. Although either oral or parenteral iron could be given, increasingly clinicians are giving parenteral iron to ensure that the haemoglobin is increased the maximal amount before the elective surgery is undertaken. During surgery, techniques are utilized to reduce or eliminate exposure to allogeneic blood. For example, electrocautery, which is a technique utilized for surgical dissection, removal of soft tissue and sealing blood vessels, can be applied to a variety of procedures. During surgical procedures that are expected to have significant blood loss, blood that is lost during surgery can be collected, filtered, washed and given back to the patient. This procedure is known as intraoperative blood salvage. Pharmacologic agents, for example tranexamic acid, can also be utilized to minimize blood loss. Another technique, acute normovolemic hemodilution, involves the collection of a selected calculated volume of the patient's own blood in collection bags prior to the start of surgery with the simultaneous replacement of an equal volume of non-blood fluid. Since the patient's blood is now diluted, blood lost during the surgical procedure, i.e. by hemorrhage, contains smaller amounts of red blood cells. The collected blood product, which contains red blood cells, platelets and coagulation factors, is reinfused at the end of the surgery. People who are in good health and not anemic may sometimes donate their own blood prior to the surgery (autologous blood donation), which helps to conserve donor units and reduces some of the risks of exposure to allogeneic blood (though autologous donation carries risks of its own). When all of these therapies are combined, blood loss is greatly reduced which correspondingly reduces or averts the potential for allogeneic blood transfusion. Additional details on this question can be found in the journal, Transfusion. Exposure to blood can be reduced, and tolerance to anemia enhanced, by using a "restrictive" transfusion strategy; for example, the AABB recommends that hospital patients in stable condition only be transfused when the hemoglobin drops below 7–8 g/dL (70–80 g/L). A maximum surgical blood order schedule (MSBOS), which lists the number of blood units typically required for a given surgical operation, can also be used to help prevent unnecessary blood orders.

Information technology in PBM Information technology can be useful in implementing a patient blood management policy, this includes:

… excerpt ends here. Continue reading the full article.

Illustrations

Worked examples

Example 1 — a first encounter with Patient blood management

Start with the simplest possible case. Write down what Patient blood management claims or describes in one sentence, then invent the smallest concrete situation in which that sentence is true. In science, the smallest case is usually a single object, a single equation or a single measurement. Check that every symbol or term in your sentence has a meaning in that case.

Example 2 — changing one variable

Take the situation from Example 1 and change exactly one quantity: double it, halve it, or set it to zero. Predict what should happen to Patient blood management before you calculate. Comparing your prediction with the result is the fastest way to find out whether you understand the idea or only the words.

Example 3 — an exam-style question

Typical questions about Patient blood management ask you to (a) state it precisely, (b) apply it to given data, and (c) explain a limitation. Practise writing all three answers in under five minutes; the third part is what separates a full-mark answer from an average one.

Applications of Patient blood management

In research: Patient blood management appears in science research whenever the underlying quantities have to be modelled precisely. Papers usually cite it as a starting assumption and then explore where it breaks down.
In technology and industry: Engineering practice reuses Patient blood management in design rules, simulations and safety margins. Knowing the idea lets you read a specification sheet and understand why the numbers look the way they do.
In the classroom: Patient blood management is common in secondary-school and first-year university syllabi. It links to neighbouring topics Health care quality, Surgery, so understanding it makes those chapters shorter.
In everyday life: Look for Patient blood management outside the textbook — in sport, cooking, traffic, electronics or the sky above you. An example you found yourself is remembered far longer than one you were given.

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How to study Patient blood management in 20 minutes

Read the reference excerpt below once, without taking notes.
Close the page and write down what Patient blood management means in your own words.
Compare your version with the excerpt and mark what you missed.
Work through the three examples above with pen and paper.
Explain Patient blood management out loud to somebody else — or to Teacher Smith in the lgStudy chat.

Frequently asked questions

What is Patient blood management in simple terms?

Why does Patient blood management matter?

Because it connects several science ideas at once: it gives you a definition you can apply, a quantity you can calculate, and a way to check whether a result is plausible.

How should I study Patient blood management?

Read the excerpt, restate it from memory, then work through the examples and applications listed on this page. The five-step study plan above takes about twenty minutes.

What does this page cover?

It gives you a compact reference excerpt plus original lgStudy explanations, examples, applications and study material on Patient blood management.