Cornerstones of patient blood management in surgery

Butcher, Anna; Richards, Toby

doi:10.1111/tme.12476

Cited by 40 publications

(34 citation statements)

References 68 publications

(72 reference statements)

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“…Iron deficiency anaemia has a complex origin, including nutritional deficiency and chronic inflammatory state resulting in absolute iron deficiency, functional iron deficiency or iron sequestration . Absolute iron deficiency is a state where iron stores are severely decreased, resulting in anaemia.…”

Section: How?mentioning

confidence: 99%

Optimisation of pre‐operative anaemia in patients before elective major surgery – why, who, when and how?

2019

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Anaemia in surgical patients is a common and serious problem; around 40% of patients presenting for major surgery are anaemic. Patients with pre-operative anaemia have significantly higher rates of morbidity and mortality and are likely to be transfused red cells. In addition, red cell transfusions are independently associated with worse outcomes. Pre-optimisation of anaemia in surgical patients leads to higher pre-operative haemoglobin concentrations and less need for transfusion. Patients undergoing major surgery (defined as blood loss > 500 ml expected or possible) should be optimised if their haemoglobin concentration is less than 130 g.l À1 on screening. Detection of anaemia should follow listing for surgery as soon as possible to allow enough time for optimisation. The most common cause of pre-operative anaemia is iron deficiency, which can be treated with iron therapy. Iron clinics should be set up in either primary or secondary care to allow for optimal treatment. In this review, we present literature supporting the optimisation of pre-operative anaemia and propose a treatment algorithm.

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Section: How?mentioning

confidence: 99%

Optimisation of pre‐operative anaemia in patients before elective major surgery – why, who, when and how?

2019

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“…Her yöntem, her hasta için uygun olmayabilir, ancak her hasta için bunların en azından birkaçının uygulanabileceği kesindir. Günümüzde farklı disiplinler ve farklı hasta gruplarında PBM ile ilgili çok sayıda yayın mevcuttur (10,(33)(34)(35)(36)(37)(38)(39) .…”

Section: Transfüzyon Gereksinimini En Aza Indirmek Için Neler Yapılabunclassified

Patient Blood Management

Heper¹

2018

İKSST

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ÖZHasta Kanı Yönetimi (HKY), gereksiz transfüzyonları önlemek yanında hastanın transfüzyon alma olasılığını en aza indirmeye ve kendi kan rezervini optimize etmeye yönelik tüm uygulamaları içeren bir kavramdır. En çok elektif cerrahiye hazırlanan hastalarda uygulanmakta olup transfüzyon miktarında önemli oranda azalma, maddi olarak tasarruf ve hasta açısından daha iyi tıbbi sonuçlar sağladığı gösterilmiştir. Bu makalede, Dünya Sağlık Örgütü'nün de sağlık uygulamalarının ayrılmaz bir parçası olması gerektiğini ilan ettiği HKY'nin temel noktaları özetlenmiştir.Anahtar kelimeler: hasta kan yönetimi, kan elemanları transfüzyonu, otolog kan transfüzyon, anemi, elektif cerrahi işlemler ABSTRACT Patient Blood Management (PBM) is a concept that includes all practices to prevent unnecessary transfusions, to minimize the possibility of the patient receiving transfusion and to optimize the patient's own blood reserve. It is most frequently used in patients being prepared foe elective surgery, and it has been shown that it is very effective in providing a significant reduction in the amount of transfusions, financial savings and better medical outcomes for the patient. This paper summarizes the key points of the PBM, which the World Health Organization has declared that it should be an integral part of health practices.

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“…It encompasses measures to avoid allogeneic blood transfusion such as anaemia management without transfusion, cell salvage and the use of anti‐fibrinolytic drugs to reduce bleeding. It ensures that patients receive the optimal treatment and that the avoidable, inappropriate use of blood and blood components is reduced (NHS, ; Butcher & Richards, ). It has been proposed that PBM should be a recognised part of best clinical practice and should be considered the standard of care for all patients (Shander et al, ,b), and managing preoperative anaemia in elective surgical patients is a key component of PBM (Butcher & Richards, ).…”

mentioning

confidence: 99%

Transfusion requirement and length of stay of anaemic surgical patients associated with a patient blood management service:a single‐Centre retrospective study

Faulds

Whately‐Smith

Clarke

2019

Transfusion Medicine

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Summary Objective To assess the value of patient blood management (PBM) in the detection and management of preoperative anaemia before elective surgery. Background PBM is recognised as the standard of care, with diagnosis and management of preoperative anaemia being the key components of PBM. No formal assessment of the value of PBM anaemia screening and correction before scheduled surgery had been made at our hospital. Methods We conducted a retrospective study in a tertiary‐care, academic hospital of consecutive records of elective surgery (n = 25 641). We excluded minor surgeries. We identified anaemic patients who had been assessed by PBM or not (non‐PBM). We calculated transfusion incidence and hospital length of stay (LOS) across all surgical specialities. Results During the 1‐year study period, 15 245 patients were eligible for inclusion; 311 patients (2·0%) were transfused, and 83·3% of transfusions were in anaemic patients. Transfusion incidence was 9·2% in anaemic PBM‐assessed patients and 17·4% in non‐PBM patients. For haemoglobin (Hb) <100 g L−1, the transfusion incidence was 22·1% [95% confidence interval (CI) 15·5–30·6%] in PBM and 40·0% (95% CI 35·1–45·0%) in non‐PBM patients, and for Hb 100–119 g L−1, it was 4·7% (95% CI 2·8–7·5%) and 7·9% (95% CI 6·3–9·8%), respectively. Overall mean LOS was 2·1 days [standard deviation (SD) 6·0]. Mean LOS with Hb <100 g L−1 was 6·7 days (SD 14·8) in PBM‐assessed patients and 12·4 days (SD 19·5) in non‐PBM patients and was 3·1 (SD 5·2) and 6·2 (SD 9·5) days, respectively, for Hb 100–119 g L−1. Conclusion Anaemic elective surgery patients assessed by patient blood management (PBM) had a markedly lower transfusion risk and shorter LOS than anaemic patients not assessed by PBM.

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Cornerstones of patient blood management in surgery

Cited by 40 publications

References 68 publications

Optimisation of pre‐operative anaemia in patients before elective major surgery – why, who, when and how?

Optimisation of pre‐operative anaemia in patients before elective major surgery – why, who, when and how?

Patient Blood Management

Transfusion requirement and length of stay of anaemic surgical patients associated with a patient blood management service:a single‐Centre retrospective study

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