Blood-Management Programs: A Clinical and Administrative Model with Program Implementation Strategies

Tokin, Christopher; Almeda, Jose Luis; Jain, Saurabh; Kim, Jennifer; Henderson, Randy; Sher, Linda; Selby, Rick

doi:10.7812/tpp/08-029

Cited by 9 publications

(9 citation statements)

References 23 publications

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“…An introduction of new health care technologies, including nucleic acid testing, improved blood dispatch and blood administration regulations, has increased the safety and costs of blood products [14,15]. It is estimated that an administration of one unit of red blood cells costs approximately US$1004-1400 [16,17]. One of the strategies to limit blood transfusions, and, thereby, reduce the incidence of its adverse outcomes, is to adopt a restrictive strategy (i.e.…”

Section: Discussionmentioning

confidence: 99%

Clinical benefits and cost‐effectiveness of allogeneic red‐blood‐cell transfusion in severe symptomatic anaemia

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Clinical benefits and cost‐effectiveness of allogeneic red‐blood‐cell transfusion in severe symptomatic anaemia

et al. 2011

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“…All 65 avoided RBC transfusion altogether , while 179 concomitant controls received 1.45 RBC units on average (i.e., a mean of 3.3 units [range, 1‐15 units] given to 44% of these subjects who needed perioperative transfusion). Jehovah's Witnesses and controls were similar in terms of age, postoperative hematocrit, and preoperative and postoperative results on basic liver function tests 39 . Outside the setting of patients with religious objections to transfusion, compared to the First Austrian Benchmark Study, 40 in the Second Austrian Benchmark Study 41 (conducted after different participating hospitals had adopted various components of PBM—Table 2), many hospitals had reductions in the number of administered RBC transfusions by as much as 50%.…”

Section: As‐low‐as‐reasonably‐achievable Risk and Patient‐centric Tramentioning

confidence: 90%

“…Through the combination of approaches listed in Table 2, PBM can avoid transfusion altogether in Jehovah's Witnesses, 39 and it can correspondingly reduce the number of exposures to allogeneic donors by up to twofold in patients without such religious objections to transfusion. Of 244 patients undergoing liver resection at the University Hospital of the University of Southern California in 1997 to 2005, 65 were Jehovah's Witnesses who had “bloodless surgery” by means of acute normovolemic hemodilution.…”

Section: As‐low‐as‐reasonably‐achievable Risk and Patient‐centric Tramentioning

confidence: 99%

“…Several alternative configurations of the future blood procurement infrastructure, including the adoption of the centralized transfusion service model on a regional or even national scale, could meet these objectives of the patient‐centric paradigm; the description of the future blood procurement infrastructure is beyond the scope of this commentary. Because most of the literature on PBM has hitherto concentrated on RBC transfusion, 24‐26,29‐45 the reduction in transfusion risk thanks to the evolution from a component‐centric to a patient‐centric transfusion medicine paradigm will be illustrated here in the context of PLT transfusion.…”

Section: As‐low‐as‐reasonably‐achievable Risk and Patient‐centric Tramentioning

confidence: 99%

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Reasons for moving toward a patient‐centric paradigm of clinical transfusion medicine practice

Vamvakas¹

2012

Transfusion

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The combination of patient blood management (PBM) modalities and multicomponent apheresis permits us to administer even safer transfusions than those using the "safer-than-ever" blood components distributed in the beginning of the 21st century. PBM identifies a patient at risk of transfusion and formulates a multidisciplinary and multimodal-yet individualized-plan for reducing the need for allogeneic transfusion. Multicomponent apheresis can collect any combination of red blood cells, platelets, and plasma from the same donor during the same donation, and it should eventually reserve all components harvested from the same donation for transfusion to the same recipient. Together, PBM and multicomponent apheresis represent a new paradigm-the patient-centric paradigm-of transfusion medicine whose purpose is to reduce the transfusion risk for each individual patient to the level of the ALARA (as-low-as-reasonably-achievable) risk. PBM and multicomponent apheresis can meet a patient's transfusion needs with at least twofold fewer allogeneic donor exposures, thereby reducing the risk of infectious and immunologic complications of transfusion by at least twofold. The reduction in risk includes the leading cause of transfusion-related mortality (transfusion-related acute lung injury) and the cardinal threat to transfusion safety (the next "HIV-like" pathogen to emerge in the future). Once it is determined that PBM and multicomponent apheresis can replace the current blood-procurement system at a "reasonable" cost and without jeopardizing the supply of blood and components, the patient-centric paradigm should replace the current, component-centric paradigm of transfusion medicine to reduce the transfusion risk to the level of the ALARA risk.

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“…In last decade, bloodless surgery and bloodless management program have been studied thoroughly and guidelines have been suggested. [15][16][17] It is being practiced at many centers nowadays. It will benefit not only individuals who are JW, but also individuals were refuse blood transfusion or not candidates due to earlier complication or possible risk.…”

Section: Bloodless Surgery 2(9%)mentioning

confidence: 99%

Management of Inflammatory Bowel Diseases in Jehovah’s Witness

Saligram¹,

Desai²,

Baidoo³

2015

Gastro Open J

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Background: Treatment of Inflammatory Bowel Disease (IBD) patients who are known to be Jehovah's Witness (JW) can be a unique challenge. JW accept most available medical treatments, but may not accept blood transfusions or blood products due to their religious beliefs. We looked at the experience of treating IBD in JW, their care during acute bleed and also the outcome. Methods: A retrospective review was performed to identify patients treated for IBD known to be JW between the years 2005-2009 at two University of Pittsburgh Medical Center Hospitals. Demographic data, clinical presentation, treatment during hospitalizations and outpatient clinics were abstracted from the chart. All patients were confirmed to be having IBD either by colonoscopy or by documented evidence during clinical care. JW was confirmed by documentation in the chart. We took note of complications secondary to IBD, treatment measures during emergent conditions like acute bleed, bowel obstruction and also different treatment options used for long term management of IBD. Results: Twenty two patients were identified in both the university (n=14) and community hospital (n=8). Out of them, 13 patients had ulcerative colitis and 9 had Crohn's disease. Caucasians comprised majority of the population (68%). Mean age was 51 years. Mean time interval between initial diagnosis and most recent follow-up was 14 years. Among study subjects, 68% had documented colonoscopy reports with 6 patients (27%) showing active disease. Nine (41%) of these patients were post surgical and 6(27%) patients developed complication (clostridium difficile, abscess, fistula, colon cancer and small bowel obstruction) secondary to their IBD. Seventeen (77%) IBD patients were treated as an outpatient and 5(23%) as an inpatient. Three (14%) patients had to be admitted to Intensive Care Unit (ICU) during their inpatient stay. Hemoglobin was more than 10 g/dl in 68%, between 7 to 10 g/dl in 18% and less than 7 g/dl in 14% at baseline. After treatment with conservative measures for anemia, hemoglobin improved to more than 10 g/dl in 91%, and between 7 to 10 g/dl in 9%. One patient died with organ failure secondary to sepsis. Two patients (9%) underwent bloodless surgery with cell saver technique with no mortality. Conclusion: Management of IBD related anemia in JW has a good outcome and can be treated conservatively without blood transfusion. Complications secondary to IBD does not adversely affect the outcome.

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Blood-Management Programs: A Clinical and Administrative Model with Program Implementation Strategies

Cited by 9 publications

References 23 publications

Clinical benefits and cost‐effectiveness of allogeneic red‐blood‐cell transfusion in severe symptomatic anaemia

Clinical benefits and cost‐effectiveness of allogeneic red‐blood‐cell transfusion in severe symptomatic anaemia

Reasons for moving toward a patient‐centric paradigm of clinical transfusion medicine practice

Management of Inflammatory Bowel Diseases in Jehovah’s Witness

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