PBM Overview
What is PBM?
“Patient Blood Management is a patient-centred, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient’s own blood, while promoting patient safety and empowerment.”
– Shander et al Anesthesia & Analgesia 2022
This the Global Definition of Patient Blood Management developed by 26 experts representing 16 international professional societies.
Better blood management with PBM can result in:
- Fewer blood transfusions
- Fewer transfusion-associated complications
- Better health and recovery outcomes
- Reduced cost implications for the health system
Why is PBM necessary?
The best and safest blood for patients is their own. As a unique and valuable resource, it should therefore be conserved and managed appropriately.
Although donor blood is thoroughly screened and tested, blood from another person has inherent risks, including:
- Allergic and immunological complications
- Storage-related complications
- Infectious risks
- Wrong blood transfused
All patients facing a medical or surgical intervention that has a risk of significant blood loss may benefit from PBM.
Health professionals therefore have a vital role to play, particularly during the peri and post-operative stages.
This includes strategies and techniques to support the 3 pillars of PBM, outlined below.
Optimising red blood cell mass before a surgical or medical intervention
- Optimising the patient’s blood levels 4-6 weeks before surgery – essentially helping the body to be its own blood bank.
- Identifying and treating anaemia (low blood levels of haemoglobin).
- Identifying and treating iron deficiency (low iron levels).
- Identifying any coagulation abnormalities needing correction or management.
Minimising blood loss during treatment
- Certain medications, including some ‘natural’ medicines and herbal and vitamin preparations, can increase bleeding or clotting at the time of a procedure. These may need to be stopped anywhere from a few days to several weeks before a procedure.
- Some underlying diseases can interfere with the blood’s ability to clot. This may increase bleeding during a procedure and therefore may require treatment ahead of time.
- Advanced, as well as conventional, surgical tools and techniques can be used to reduce bleeding.
- Various anaesthetic techniques can be used, such as controlling blood pressure, maintaining normal body temperature, and collecting and recycling the patient’s own blood during and after a procedure.
- Medications that reduce bleeding can be given.
- Smaller and less frequent samples of blood can be taken for tests.
Optimise recovery & manage anaemia
- Several non-blood fluids are available to restore blood volume immediately after blood loss.
- With appropriate management, the body can tolerate lower blood levels than previously thought, without resorting to blood transfusion.
- Blood-building medications and nutritional support can help the body make its own new blood more rapidly.
