1 Introduction
Patient blood management aims to improve clinical outcomes by avoiding unnecessary exposure to blood components. It includes the three pillars of:
- optimisation of blood volume and red cell mass
- minimisation of blood loss
- optimisation of the patient's tolerance of anaemia
Patient blood management optimises the use of donor blood and reduces transfusion-associated risk.
If the patient requires therapy for anaemia, thrombocytopaenia or coagulopathy, transfusion should not be a default decision. Instead, the decision on whether to transfuse should be carefully considered, taking into account the full range of available therapies, and balancing the evidence for efficacy and improved clinical outcome against the potential risks (Appendix B). In the process of obtaining informed consent, a clinician should allow the patient sufficient time to ask questions, and should answer those questions.
This document, Patient Blood Management Guidelines: Module 3 – Medical, is the third in a series of six modules that focus on evidence-based patient blood management. The other five modules are listed in Table 1.1, below. Together, Module 2 (Perioperative) and Module 3 (Medical) cover all the patient groups addressed by the 2001 document Clinical Practice Guidelines on the Use of Blood Components1 (National Health and Medical Research Council/Australasian Society of Blood Transfusion, NHMRC/ASBT). Thus, the 2001 guidelines have now been replaced.
This module is intended to assist and guide 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. Transfusion decisions for patients should also take into account each individual’s clinical circumstances and physiological status, and their treatment preferences and choices.
Revision of the 2001 guidelines1 was needed because of the:
- increasing evidence of transfusion-related adverse outcomes, leading to the emergence of new practices, including restrictive transfusion strategies and the increased use of alternatives to transfusion in the management of anaemia
- variable (and frequently poor) compliance with recommendations of the guidelines, indicated by a high degree of variation in transfusion practices
- failure of the guidelines to address a range of clinical settings where blood management is commonly required, including critical bleeding and massive transfusion, chronic medical conditions, obstetrics and paediatrics.