Patient Blood Management (PBM)

As defined by one of the leaders in the field, Dr. Tim Hannon, blood management (also called “patient blood management”) is “an evidence-based, multidisciplinary process that is designed to promote the optimal use of blood products throughout the hospital.” That definition works well, as transfusion decisions have been made far too often in the past based on feelings, thin evidence, and whims!

Patient blood management programs typically have three areas of emphasis:

  • Recognizing and treating pre-operative anemia (See episode 052 of the Blood Bank Guy Essentials Podcast for a great discussion on this topic)
  • Minimizing intraoperative and postoperative blood loss
  • Making evidence-based transfusion choices throughout the process

All of these programs emphasize an honest look at the risks of transfusion in comparison to the benefits, and they also embrace evaluation of alternatives to transfusion. Given the current uncertainty regarding health care costs in the US, hospitals across the country are taking a fresh look at the use of blood management programs (either outsourced or developed in-house) to try to reduce the cost of transfusion (both the direct cost of the products and the possible increased costs resulting from transfusion complications).

A true blood management program goes far beyond the basics of gathering statistics about transfusion! Implementing transfusion guidelines based on published evidence and monitoring and evaluating transfusion practice by providers in a given facility are both key steps. It is important to understand that the intent behind blood management is NOT that all transfusions are inappropriate, but that blood should be used only when truly indicated.

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