Patient Blood Management (PBM) is an evidence-based bundle of care to optimise medical and surgical patient clinical outcomes by managing and preserving the patient's blood. Patient blood management is not an ‘intervention’, not an alternative to transfusion, it is good scientifically-based good clinical medicine. Blood transfusion is a major medical ‘intervention’ and its use should be based on sound evidence-based clinical medicine. PBM is a good news story for patients and the health care system. Advocating PBM can be challenging, requiring engagement of clinicians and the health system to be implemented and successful in the long-term. To the media PBM is probably viewed as; “What’s new, PBM is boring, why aren’t all doctors practicing PBM as standard of care?”
If the following are the core elements of PBM that need coordinating, managing and auditing, what is the story those passionate about PBM should be trumpeting?
PBM is not primarily about reducing blood transfusions but improving patient care. A positive corollary is avoiding inappropriate blood transfusion, ensuring appropriate use and availability of altruistically donated blood and respecting what donors expect when they donate blood. Further down the corollary line is saving of the health dollar. There is a good news or bad news story for the media depending on one’s point of view. There is the risk of adversely impacting on the blood donor base that is already under challenging pressures. There is also the issue that the blood sector in general is coming under threat from the success of PBM, especially in countries where there are significant commercial interests. We are fortunate in Australia that we have achieved a relatively seamless connection from patient care to the highest levels of State and Federal Government. However, there have been concerns about pushback in the US and Europe to PBM that appears due to successes of PBM impacting on commercial interests of the blood sector.
The story and core elements of PBM to get over to clinical practioce and the community may appear complex and it is sometimes forgotten that the foundations of modern scientifically evidence-based medical management presuppose an understanding of the structure and function of the normal, pathophysiology of disease, diagnosis and indicators for severity of disease as well as understanding the natural history and consequences of untreated disease. These principles are implicit in the three pillars of PBM.
This might all be too much for some health professionals or regarded as boring. However, we must have a clear idea as to how PBM is defined and the language use. PBM is a “simple” concept, but its communication and implementation can be challenging.
The three-pillar matrix of PBM
1st Pillar: Optimize erythropoiesis
2nd Pillar: Minimize blood loss & bleeding
3rd Pillar: Tolerate anaemia by harnessing & optimising physiological reserves
Clinical practice of the three-pillar matrix is determined by: