Patient blood management is a win-win: a wake-up call

Spahn, Donat R.; Theusinger, Oliver M.; Hofmann, Axel

doi:10.1093/bja/aes166

Cited by 55 publications

(41 citation statements)

References 30 publications

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“…In clinical practice, anaemia is the main predictor of red cell transfusion [27], and this is independently associated with increased morbidity and mortality as mentioned before [10][11][12]28].…”

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confidence: 88%

“…Observational studies suggest that patients who receive allogeneic red cell transfusion are at increased risk of mortality, ischaemic complications, delayed wound healing, and increased length of stay [10][11][12]. However, it is not clear whether this link is causal or associative, as the findings of most observational studies are confounded by the fact that sicker patients, with associated worse clinical outcomes receive more blood.…”

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confidence: 99%

“…In the peri-operative setting, patient blood management is a relatively recent concept based on three pillars -(i) detection and treatment of pre-operative anaemia; (ii) reduction in peri-operative blood loss; (iii) harnessing the patient-specific physiological reserve of anaemia [10]. These strategies are discussed elsewhere in this journal.…”

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confidence: 99%

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Evidence and triggers for the transfusion of blood and blood products

2014

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SummaryAllogeneic red cell transfusion is a commonly used treatment to improve the oxygen carrying capacity of blood during the peri-operative period. Increasing arterial oxygen content by increasing haemoglobin does not necessarily increase tissue oxygen delivery or uptake. Although the evidence-base for red cell transfusion practice is incomplete, randomised studies across a range of clinical settings, including surgery, consistently support the restrictive use of red cells, with no evidence of benefit for maintaining patients at higher haemoglobin thresholds (liberal strategy). A recent meta-analysis of 7593 patients concluded that a restrictive transfusion strategy was associated with a reduced risk of healthcare-associated infections (pneumonia, mediastinitis, wound infection, sepsis) when compared with a liberal transfusion strategy. The degree to which the optimal haemoglobin concentration or transfusion trigger should be modified for patients with additional specific risk factors (e.g. ischaemic heart disease), remains less clear and requires further research. Although most clinical practice guidelines recommend restrictive use of red cells, and many blood transfusion services have seen marked falls in overall usage of red cells, the use of other blood components such as fresh frozen plasma, platelets, and cryoprecipitate has risen. In clinical practice, administration of fresh frozen plasma is usually guided by laboratory tests of coagulation, mainly prothrombin time, international normalised ratio and activated partial thromboplastin time, but the predictive value of these tests to predict bleeding is poor.

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confidence: 88%

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confidence: 99%

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Evidence and triggers for the transfusion of blood and blood products

2014

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“…Patient blood management (PBM) is a programme or collection of approaches tailored to the individual patient aimed at minimizing the need for red cell transfusion and thus improving postoperative outcomes. 80,[93][94][95][96][97][98] It centres on three 'pillars' (first, optimization of haemopoesis; second, minimizing blood loss and bleeding; and third, optimizing tolerance of anaemia) all of which have a preoperative, intraoperative and postoperative component. This approach is established in Australia and several centres in the USA but has been inconsistently adopted in Europe.…”

Section: Patient Blood Managementmentioning

confidence: 99%

Anaemia in the older surgical patient: a review of prevalence, causes, implications and management

et al. 2013

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SummaryThis review provides the clinician with a summary of the causes, implications and potential treatments for the management of anaemia in the older surgical patient. The prevalence of anaemia increases with age and is frequently identified in older surgical patients. Anaemia is associated with increased postoperative morbidity and mortality. Allogenic blood transfusion is commonly used to treat anaemia but involves inherent risks and may worsen outcomes. Various strategies for the correction of preand postoperative anaemia have evolved. These include correction of nutritional deficiencies and the use of intravenous iron and erythropoesis stimulating therapy. Clear differences exist between the elective and emergency surgical populations and the translation of research findings into these individual clinical settings requires more work. This should lead to a standardized approach to the management of this frequently encountered clinical scenario.

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“…The use of a POC, goal directed transfusion algorithm improves outcomes in cases of massive hemorrhage (Spahn et al 2008(Spahn et al , 2012Ganter and Spahn 2010 ;Gorlinger et al 2011 ;Liumbruno et al 2011 ;Young et al 2011 ;Theusinger et al 2014 ).…”

Section: Monitoringmentioning

confidence: 99%