Patient Blood Management – A new standard of care

Transfusion of blood components is one of the most widely performed medical procedures around the world. Although it can be life-saving in many critical situations, it also carries inherent risks, such as infections, respiratory complications and immunomodulation, which can increase patient morbidity and mortality. Approaches to reduce the number of unnecessary transfusions are therefore of great interest for improving patient safety.

How can we optimise perioperative bleeding management?

Professor Thorsten Haas, Head of the Patient Blood Management (PBM) programme at the Children’s Hospital in Zürich, Switzerland, explains the concept of PBM, a multidisciplinary, evidence-based approach to individualising patient care recommended by many medical societies. “The objectives of PBM are primarily patient-centred”, says Professor Haas. “Our goal is to use point of care, targeted bleeding management in order to minimise the use of blood products and improve patient outcomes.”

Avoiding blood transfusion can be very straightforward. “In some cases, simply supplementing iron in a preoperative patient suffering from iron deficiency anaemia can remove the need for transfusion” remarks Professor Haas.

Unnecessary transfusions can also be reduced by the use of specific coagulation factor concentrates instead of blood components such as plasma. Administration of blood component is not only associated with potential risks, such as acute lung injury and circulatory overload, but is also time consuming.

Fibrinogen is often the only deficiency that needs to be treated

Fibrinogen, a protein necessary for clot formation, is the first factor to become deficient during perioperative bleeding and is often the only deficiency that needs to be treated. “Fibrinogen concentrate allows the administration of a precise dose to reach your desired target level, it is immediately available, and you have a really excellent safety profile” confirms Professor Haas. “In bleeding patients with hypofibrinogenemia, administration of fibrinogen concentrate is always our first choice.”

The importance of sharing knowledge and expertise

Although PBM is a relatively new and evolving approach, increased adoption around the world is expected given the benefits it offers both for patients and the hospital, including less wastage of blood products, shorter ICU and hospital length of stay, and reduced healthcare costs.

“We are excited to share our experiences and we feel happy to support other regions that are starting to work on such concepts for a safer management of bleeding patients” concludes Professor Haas.