Patient Blood Management

 

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Patient Blood Management Guidelines

Visit Patient Blood Management Guidelines to access the latest modules in the Guidelines or click on the images below to go directly to the relevant module.

Guidelines - Critical Bleeding Massive Transfusion Gudelines - Perioperative  Guidelines - Medical Gudielines - Critical Care

What is PBM?

Patient Blood Management improves patient outcomes by improving the patient’s medical and surgical management in ways that boost and conserve the patient’s own blood. As a consequence of better management, patients usually require fewer transfusions of donated blood components thus avoiding transfusion-associated complications. The National Blood Authority is funding and managing the development of evidence-based, Patient Blood Management Guidelines. A multidisciplinary team determines, with the patient, the specific management plan, which makes every reasonable endeavour to optimise the patient’s own blood volume, minimise blood loss, and optimise the patient’s physiological tolerance of anaemia. There are various techniques to ensure this. For example, the Three Pillars of PBM [1] model depicted below helps to show how various practices can be initiated during pre-, intra- and post-operative stages of surgery.

TABLE: Three pillars of PBM

STAGE/PILLAR Pillar 1: Optimise red cell mass Pillar 2: Minimise blood loss and bleeding Pillar 3: Harness and  optimise physiological reserve of anaemia
Preoperative
  • detect/treat anaemia and iron deficiency
  • treat underlying causes
  • optimise haemoglobin
  • cease medications
  • identify, manage and treat bleeding/bleeding risk
  • minimise phlebotomy
  • plan/rehearse procedure
  • patient’s bleeding history and develop management plan
  • estimate the patient’s tolerance for blood loss
  • optimise cardiopulmonary function
Intraoperative
  • time surgery with optimisation of erythropoiesis and red blood cell mass
  • meticulous haemostasis/ surgical/anaesthetic techniques
  • cell salvage techniques
  • avoid coagulopathy
  • patient positioning/ warming
  • pharmacological agents
  • optimise cardiopulmonary function
  • optimise ventilation and oxygenation
  • restrictive transfusion strategies e.g. single unit policy
Postoperative
  • manage anaemia and iron deficiency
  • manage medications and potential interactions
  • monitor and manage post op bleeding
  • keep patient warm
  • minimise phlebotomy
  • awareness of drug interactions and adverse events
  • treat infections promptly
  • maximise oxygen delivery
  • minimise oxygen use
  • treat infections promptly
  • tolerance of anaemia
  • restrictive transfusion strategies

The rationale for patient blood management addresses evidence-based transfusion medicine practice and stewardship of donated blood, to:

  • view a patient’s own blood as a valuable and unique natural resource that should be conserved and managed appropriately
  • acknowledge that altruistically donated blood is a valuable, unique and costly resource that is held in trust, and that it will only be used as therapy when there is evidence for potential benefit and potential harm will be minimised
  • consider transfusion alternatives
  • ensure quality products are available in a timely and safe manner
  • ensure potential hazards are considered and balanced  against the benefits, and
  • explain the benefits and risks to the patient/relatives.

Implementing PBM

Visit Implementing the Patient Blood Management Guidelines to access the latest tools and information to support health providers implementing PBM strategies. On this page you will also find the NBA's PBM Guidelines Implementation Strategy.

Image of cover page of PBM Implementation Strategy

Patient Blood Management Steering Committee (PBMSC)

The National Blood Authority (NBA) has established an ongoing committee to provide advice and guidance on strategies to increase the uptake of patient blood management practices in Australia.

The PBMSC has representatives from both clinical and government sectors with expertise and knowledge of blood management, the health sector, and quality and safety issues.

The work of the PBMSC supports the uptake of the Patient Blood Management Guidelines.

  1. Adapted from Spahn DR. Goodnough LT. Alternatives to Blood Transfusion. Lancet 2013; 381:1855-65; Hofman A. Farmer S. Towler SC. Strategies to preempt and reduce the use of blood products: an Australian perspective. Curr Opin Anaesthesiol. 2012; 25:66-73; Isbister JP. The three-pillar matrix of patient blood management – an overview. Best Pract Res Clin Anaesthesiol. 2013; 27:69-84.