Allogeneic blood transfusion is the default treatment for blood loss and anaemia. It has saved lives in some patients with massive bleeding, but has resulted in serious adverse effects in others. Despite advancement in laboratory tests to make donor blood safer, allogeneic blood transfusion still has recognised serious hazards such as acute haemolytic reactions, transfusion-transmitted infections, immunomodulation, acute lung injury and circulatory overload, among others, according to the Serious Hazards of Transfusion (SHOT) report, the UK hemovigilance system. [1] The HIV epidemic greatly changed the transfusion practices of many clinicians. Other drivers for change in transfusion practice are the limited blood supply, the rising costs of transfusion therapy, and the demand for transfusion-free medical and surgical management by patients for whom blood is not an option.  All these factors have prompted healthcare professionals to resort to blood conservation strategies.  

There is a paradigm shift from Transfusion Medicine to Patient Blood Management.  In Transfusion Medicine, strategies applied are product-focused, to make blood transfusion as safe as possible. Emphasis is more on the appropriate use of blood products, thus transfusion guidelines and  transfusion thresholds are drawn. [2, 3]

Patient Blood Management (PBM) is “the timely application of evidence-based medical and surgical approaches to manage anemia, optimize hemostasis,  and minimise blood loss and blood transfusion in order to improve patient outcomes.” It is patient-focused, multidisciplinary and places more emphasis on preventive measures because “it preempts and significantly reduces the resort to transfusions by addressing modifiable risk factors, such as anemia and bleeding, that may result in transfusion long before a transfusion may even be considered.” [3]

The pillars or principles of PBM are:  

  1. optimizing hematopoiesis or the patient’s native RBC mass; 
  2. minimising bleeding and blood loss; and 
  3. harnessing and optimising patient’s tolerance of anemia. 

Each pillar employs multiple strategies which are applied in the pre-, intra- and postoperative phases in surgical patients, thus PBM is multimodal. Each strategy can minimise blood loss and the risk of receiving a transfusion, and a combination of strategies is more effective. [2,3]

Patient Blood Management requires a holistic approach to patient care and should be applied to all patients, whether they refuse or accept blood transfusion. In May 2010, the 63rd World Health Assembly adopted resolution WHA63.12 on “Availability, safety, and quality of blood products,” requesting the Director-General of WHO “to provide guidance, training and support to Member States on safe and rational use of blood products…and patient blood management.” [4]

 

You may want to check out the photo from the event

 

You may want to view the actual proceedings

 

References:

[1] Serious Hazards of Transfusion (SHOT), February 2013

[2] Hofmann A, Farmer S and Shander A. Five Drivers Shifting the Paradigm from Product-Focused Transfusion Practice to Patient Blood Management. The Oncologist, 16:3-11, 2011. 

[3] Shander A, et al. From Bloodless Surgery to Patient Blood Management. Mount Sinai Journal of  Medicine 79: 56-65, 2012.

[4] Concept Paper. World Health Organisation Global Forum for Blood Safety: Patient Blood 

         Management. 14-15 March 2011, Dubai.

 

About the Speaker

 Aryeh Shander, MD, FCCM, FCC

Chief, Department of Anesthesiology, Critical Care Medicine,
Pain Management and Hyperbaric Medicine
Englewood Hospital and Medical Center, New Jersey

Clinical Professor of Anaesthesiology, Medicine and Surgery, 
Mount Sinai School of Medicine, Mount Sinai Hospital, New York

Executive Medical Director
The Institute for Patient Blood Management &
Bloodless Medicine and Surgery
Englewood Hospital and Medical Center

 

Dr. Aryeh Shander received his medical degree from the University of Vermont College of Medicine and completed his residency in Internal Medicine at Montefiore Medical Centre in New York, where he also served as chief resident. He went on to get a fellowship in Critical Care Medicine and residency in Anaesthesiology, both at the same institution. He is board certified in Internal Medicine, Critical Care, Anaesthesiology and Hyperbaric Medicine.

He sits in consultation and advisory boards:  in the US Department of Health on blood safety , the Joint Commission, and on National Disaster Preparedness, among others. He also sits in editorial boards of several prestigious peer-reviewed medical journals such as the American Journal of Medicine, American Journal of OB-Gyn, Anesthesia & Analgesia, Critical Care Medicine, Transfusion Alternatives in Transfusion Medicine, and a lot more.

He is an author/editor of books and contributes to textbooks on blood management, anesthesiology and critical care  His publications have appeared in several prestigious peer-reviewed medical journals.

He is an accomplished teacher for which he earned the Excellence in Clinical Teaching Award and the Physician’s Recognition Award in CME by the American Medical Association.

In 1997, Dr. Shander was recognised by Time Magazine  as one of America’s “Heroes of Medicine,” for his work on Bloodless Surgery. He is a founding member of the Board of Directors of the Society for the Advancement of Blood Management (SABM) and the National Anemia Action Council, and the American Society of Critical Care Anesthesiologists. He chairs the Committee on Patient Blood Management of the American Society of Anesthesiologists .  

He lectures nationally and internationally on various topics related to anesthesiology, critical care medicine, and patient blood management, notably, blood conservation in medical and surgical patients; volume resuscitation, management of anemia, perfusion techniques, novel homeostatic agents, and artificial blood.