Clinical Transfusion

1. Potential benefits to patients and the healthcare system

Blood transfusion may be essential, even life-saving in the management of various conditions. However, donated blood has various risks with potential adverse events and is a limited resource. PBM can help improve patient outcomes by promoting the use of transfusion of blood and components only when clearly required. This minimises unnecessary transfusion, reducing the risk of adverse events and thereby conserving limited donor blood for patients with the greatest need.

In elective surgery the principles of PBM have been described as the so called '3 pillars' namely:

  1. Optimizing the patient's own blood (e.g. pre-operative optimization of haemoglobin and haemostasis)
  2. Minimising surgical blood loss
  3. Optimizing the patient's physiological reserve in relation to anaemia (including use of restrictive transfusion triggers)

However the key principles of PBM apply not just to surgery but to all patients who may need a blood transfusion (medical, obstetric, paediatrics), and to both elective and emergency clinical settings.

The overall use of red cells is decreasing in many countries but large audits still show much inappropriate use. Greater scrutiny is also needed in relation to appropriate use of platelet and plasma transfusion.

Accordingly, PBM covers all aspects of decision-making in transfusion therapy, including patient evaluation and clinical management with use of appropriate indications and triggers, minimization of blood loss and optimization of the patient's own red cell mass. By reducing the need for allogeneic blood transfusions and minimising risks and unnecessary work, PBM can also reduce health-care costs.

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Adapted from AABB.

Figure 1: Pragmatic approach to embedding PBM in a tertiary hospital

From Leahy MF et al

Copyright approval received from Wiley; no further reproduction without approval.

The Figure shows blood product use per admission (all admissions) between 2008 to 2011 (p<0.001 for RBC usage per admission).

  • The experience of one regional programme: even while hospital activity increased, transfusions rates reduced over time 
  • Patient admissions increased by 22% 

 

 

  1. Patient blood management. Goodnough LT & Shander A. Anesthesiology 2012; 116:1367-76.
  2. Transfusing blood safely and appropriately. Murphy MF et al. BMJ 2013;347 :f4303
  3. Restrictive blood transfusion practices are associated with improved patient outcomes. Goodnough LT et al. Transfusion 2014; 54: 2753–2759.
  4. Increased hospital costs associated with red blood cell transfusion. Trentino KM et al. Transfusion 2015; 55: 1082–1089.
  5. A pragmatic approach to embedding patient blood management in a tertiary hospital. Leahy MF et al. Transfusion 2014;54: 1133-45.
  6. Improving red cell transfusion in the elective surgical setting: an improvement collaborative with evaluation. Harrison BT et al. Vox Sanguinis 2015; 108: 393–402.

CONTRIBUTORS

Shubha Allard

Shubha Allard

author

E-mail
United Kingdom

Erica Wood

Erica Wood

author

E-mail
Australia

Disclaimer

The content of this resource has been developed and reviewed by members of the ISBT Clinical Transfusion Working Party and should be used at the discretion of healthcare professionals utilising this clinical resource. The authors or the International Society of Blood Transfusion cannot accept legal responsibility for the content of this resource.