Patient Case Study: IDA and gallstones
Details the diagnosis and treatment of a woman with iron deficiency anaemia and gallstones in line with PBM best practice.
What is Patient Blood Management?
Patient Blood Management (PBM) is a patient-focussed, multidisciplinary approach to conserve a patient’s own blood by screening and treating anaemia, minimising bleeding during medical treatment, and supporting patients while the appropriate treatment is being initiated.
All patients facing a medical or surgical intervention that has a risk of blood loss may benefit from PBM.
Why is PBM necessary?
The best and safest blood to have circulating in your body is your own. It is a unique and valuable resource, and should be conserved and managed appropriately.
In life-threatening blood loss, blood transfusion can be a life-saving procedure. However, while donor blood is thoroughly screened and tested, a blood transfusion is essentially a liquid organ transplant, and is not without risk. Therefore, as far as possible, all efforts should be made to minimise exposure to blood transfusions.
Your role in PBM
As a patient, you have the right to participate in the decision-making process. When it comes to medical procedures you need to give permission, or what is called informed consent.
If you have any questions, concerns or objections it is extremely important that you discuss them with your GP or specialist, who can also explain transfusion risks, benefits and alternatives.
Before your surgical or medical intervention, you may wish to ask questions such as:
For your GP
- Am I anaemic or are my iron levels low?
- If so, how can it be treated before my procedure?
- Are there any medications, herbal or vitamin supplements I should stop taking before my procedure?
For your specialist
- Is there a possibility of blood transfusion with my planned procedure?
- Besides the risk of infection, are there other complications from transfusion that I should be aware of?
- What options are available to avoid transfusion in my procedure?
- If it gets to a point where you think a transfusion becomes unavoidable, can you limit the amount of blood you give me?
Why Patient Blood Management is good for the blood supply
It is becoming increasingly costly and difficult to maintain an adequate and safe supply of blood components. Stock is sometimes at very low levels. The age group of potential donors is shrinking, and the age group that uses the most blood is increasing.
Vigilant screening and testing for potentially infectious agents result in increased
donor exclusions and dramatically increase the cost of blood. These challenges will grow as the population ages. PBM can significantly reduce demand on already stretched supply of blood components. The Australian Red Cross Lifeblood has always advocated the use of blood components when clinically indicated and enthusiastically endorses the WA PBM Program.
How does Patient Blood Management work?
PBM best practice is centred around three principles, each with a number of clinical interventions.
1. Optimising blood levels before surgical or medical intervention:
- Optimising your blood levels 4-6 weeks prior to surgery – essentially helping the body 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.
2. Losing less blood throughout your 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 and conventional surgical tools and techniques can be used to reduce bleeding.
- A number of 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 the procedure.
- Medications that reduce bleeding can be given.
- Smaller and less frequent samples of blood can be taken for tests.
3. Optimise recovery
- A number of 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.
When these three principles are applied in a coordinated patient and clinical team approach, the majority of elective procedures can be performed without blood transfusion, which can result in better outcomes for you as a patient.
When will Patient Blood Management be available to Western Australians?
Western Australia are global pioneers in PBM and have for several years been sharing their expertise nationally and around the world. PBM has been implemented across the entire WA health system and an audit tool is being developed to gauge the extent to which this implementation has been adopted.
Local, national and international experts in the field of PBM lead an education program to familiarise doctors, nurses, scientists and other allied health professionals with this new standard of care.
