Implementing a patient blood management programme in Brazil: challenges and implications for developing countries

Abstract

Background Patient blood management (PBM) programmes have the intention of promoting the rational use of blood, relying on up‐to‐date medical‐scientific evidence in a multidisciplinary approach, where the patient is the main focus of transfusion decisions. These programmes not only increase patient safety levels, but they also have the potential of lowering hospital costs. The aim of this study was to describe the implementation of a PBM programme at a University hospital in Brazil. Study design and methods The discussions regarding this PBM project were initially undertaken among the managers of the hospital's Transfusion Unit. Audits of transfusion practices were carried out, and these indices were presented in meetings with the Transfusion Committee and with other important stakeholders, in order for this information to support the delineation of the programme's work fronts. Results The project was promptly approved by the hospital's Board of Directors due to the relevance of the proposal, which required few financial resources as the project is mainly based on reorganization of workflows. The measures implemented included the following: didactic sessions aimed at the hospital staff, reformulation of the computerized system for the prescription of blood components, elaboration of a protocol for the use of antifibrinolytic drugs during the perioperative period and the institution of an outpatient clinic for evaluation of preoperative anaemia. Conclusion The benefits and challenges of a PBM project in a country with limited resources are analysed, discussing specificities in the scope of Brazilian Transfusion Medicine in a pioneering way.

Implementation of a patient blood management program based on a low-income country-adapted clinical decision support system

“…The latter are associated with fewer guideline deviations, by a more highly transfusion-educated physician and frequently after a discussion with the blood bank team. The RBC transfusions are ordered by any physician, with a higher propensity for out-of-protocol requests 11 …”

Association of preoperative anemia and increased risk of blood transfusion and length of hospital stay in adults undergoing hip and knee arthroplasty: An observational study in a single tertiary center

“…Restrictive trigger has been used by many centers to reduce the allogeneic perioperative transfusion for their patients. 10,11 However, even if restrictive trigger is used with less units transfused, blood transfusion is also associated with a worse postoperative outcome in surgical and critically ill patients. A large study that compared the effect of red cell transfusion showed higher rates of morbidity and mortality in patients receiving one unit of red cells compared with patients who were not transfused.…”

“…In less developed health systems, such as the Brazilian health system, few isolated initiatives can be identified. 11 This study is part of a larger project to implement a PBM program in our institution.…”

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management

“…In Brazil, Benites et al reported a positive experience implementing a PBM program in a university hospital. 8 According to the authors, “The project was promptly approved by the hospital Board due to the relevance of the proposal, which required few financial resources, as the project is mainly based on the reorganization of workflows”.…”