Overview of patient blood management

Patient blood management (PBM) improves patient outcomes by improving the patient's medical and surgical management in ways that boost and conserve the patient's own blood.

When a PBM approach is used, patients usually need fewer transfusions of donated blood components. This means patients avoid the risks associated with transfusion.

Reasons for PBM

PBM is based on evidence about blood transfusions and the appropriate use of donated blood. PBM encourages you 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
  • explain the benefits and risks to the patient/relatives.

How PBM works

The patient's healthcare team works with the patient to determine their treatment management plan and how to use PBM. Under the Three Pillars of PBM model, the plan should make every effort to:

  1. optimise the patient’s own blood volume
  2. minimise blood loss
  3. optimise the patient’s physiological tolerance of anaemia.
     

The Three Pillars of PBM

The Three Pillars of PBM model shows how to use PBM practices to enhance and conserve a patient's own blood.

Pillar 1

Optimise red blood cell mass

Pillar 2

Minimise blood loss

Pillar 3

Manage anaemia

Perioperative

  • Detect/treat anaemia and iron deficiency.
  • Treat underlying causes.
  • Optimise haemoglobin.
  • Cease medications.

Intraoperative:

  • Time surgery with optimisation of erythropoiesis and red blood cell mass.

Postoperative:

  • Manage anaemia and iron deficiency.
  • Manage medications and potential interactions.

Perioperative:

  • Identify, manage and treat bleeding/bleeding risk.
  • Minimise phlebotomy.
  • Plan/rehearse procedure.

Intraoperative:

  • Use meticulous haemostasis / surgical / anaesthetic techniques.
  • Consider using cell salvage techniques.
  • Avoid coagulopathy.
  • Use appropriate patient positioning/warming.
  • Use appropriate pharmacological agents, where required.

Postoperative:

  • Monitor and manage post-operative bleeding.
  • Keep the patient warm.
  • Minimise phlebotomy.
  • Be aware of drug interactions and adverse events.
  • Treat infections promptly.

Perioperative:

  • Review and discuss with the patient their bleeding history and develop a management plan.
  • Estimate the patient's tolerance for blood loss.
  • Optimise cardiopulmonary function.

Intraoperative:

  • Optimise cardiopulmonary function.
  • Optimise ventilation and oxygenation.
  • Use restrictive transfusion strategies.

Postoperative:

  • Maximise oxygen delivery.
  • Minimise oxygen use.
  • Treat infections promptly.
  • Optimise tolerance of anaemia.
  • Use restrictive transfusion strategies.

 

Patient blood management video for patients

This video can help patients understand what PBM is.


Transcript is available here:

Patient blood management video for patients transcript (pdf)

 

PBM Guidelines

This video explains how the PBM Guidelines were developed.

Transcript

PBM Guidelines video transcript (pdf)

You can also watch:

We fund and manage the development and publication of the PBM Guidelines. The PBM Guidelines reflect a systematic review of the scientific literature and clinical expert consensus.

We're updating the PBM Guidelines – see the latest update.

Register for updates through BloodPortal(Opens in a new tab/window).

Modules 1 to 6

Patient blood management guideline for adults with critical bleeding

This module provides updated clinical guidance for health professionals providing immediate in-hospital care for adults with critical bleeding, including the use of a major haemorrhage protocol (MHP) to guide the use of blood components, blood products and blood conservation strategies.

Patient Blood Management Guidelines: Module 2 Perioperative

This module informs healthcare practitioners, health educators, health service managers and policymakers about the pre-, intra- and post-operative care of patients undergoing surgery or invasive procedures, particularly those in which blood loss is anticipated.

Patient Blood Management Guidelines: Module 3 Medical

This module assists and guides clinical decisions and coordination of health care across the primary, secondary and tertiary care settings for patients with acute or chronic medical conditions requiring haematological intervention.

Patient Blood Management Guidelines: Module 4 Critical Care

This module assists and guides healthcare professionals in making clinical decisions when managing patients requiring critical care.

Patient Blood Management Guidelines: Module 5 Obstetrics and Maternity

This module assists and guides healthcare professionals in making clinical decisions when managing pregnant and postpartum women.

Patient Blood Management Guidelines: Module 6 Neonatal and Paediatrics

This module assists and guides healthcare professionals in making clinical decisions about blood management in neonatal and paediatric patients.

Patient Blood Management Advisory Committee

The Patient Blood Management Advisory Committee gives us advice and guidance about implementing patient blood management in Australia. A key role is to support the development of the National Patient Blood Management Implementation Strategy.

Its members have expertise and knowledge in the health sector, blood management, education, quality and safety, and consumer issues.

Resources for implementing PBM

We developed the National Patient Blood Management Implementation Strategy 2017–2024 to increase awareness, improve understanding and support the implementation of PBM.

Since the PBM guidelines and strategy were launched, the use of red blood cells in Australia has reduced.

To implement PBM strategies, look at our tools and resources.

Other information

To promote safe transfusion practices, Lifeblood has developed a Transfusion Orientation Pack(Opens in a new tab/window).

The Australian & New Zealand Society of Blood Transfusion(Opens in a new tab/window) promotes improved knowledge and standards in the practice of blood transfusions.

Access courses on safe clinical transfusion practice and effective patient blood management through BloodSafe eLearning Australia(Opens in a new tab/window).

The Royal College of Pathologists of Australasia publishes frameworks and standards(Opens in a new tab/window) containing recommendations and guidelines for pathologists and pathology laboratories for the preparation of structured reports for iron studies.

Get in touch

For enquiries about the PBM Guidelines, contact:

Email: guidelines@blood.gov.au

Post:
Patient Blood Management Guidelines
National Blood Authority
Locked Bag 8430
Canberra ACT 2601

For general enquiries about PBM, please contact us.

Last updated: 27 Mar 2024

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