- There are six evidence-based patient blood management guidelines to improve the appropriateness of transfusion and reduce unnecessary transfusions.
- The resources are intended to help health services implement the guidelines, and to improve anaemia identification and management.
PBM addresses evidence-based transfusion medicine practices and stewardship of donated blood. The PBM view is that a patient’s own blood is a valuable and unique resource that should be conserved and managed appropriately. Altruistically donated blood is a costly resource that is also valuable and unique and should only be used when there is evidence for potential benefit and that potential harm is minimised (NBA: Patient Blood Management (PBM) | National Blood Authority, viewed Dec 2020).
A caveat on information supplied
All information and policies that are included as examples are only current at the time the document(s) were made available to Blood Matters. Individual health services should be contacted to ascertain the currency of the policies and practices. The tools are not endorsed by Blood Matters unless stated otherwise. Information sharing occurs on the understanding that due acknowledgement will be given to the original source. Seek permission from the original source before using or applying any policy, protocol or guidelines.
Patient Blood Management Guidelines
Six evidence-based modules make up the Patient blood management guidelines. Each module represents a systematic review of the scientific literature by experts from relevant colleges and societies and consumer groups.
Pre-operative anaemia assessment and red cell optimisation – just good practice
Pre-operative anaemia assessment and management is one of the cornerstones of PBM. When successfully implemented it can prevent unnecessary blood transfusions.
Anaemia should be viewed as a potentially serious, but treatable medical condition. Even mild anaemia can have significant ramifications for surgical patients. Implementation of anaemia management to improve haemoglobin (Hb), and iron stores in the elective surgery setting will improve patient outcomes.
Whenever clinically feasible, patients undergoing elective surgery with a high risk of severe post-operative anaemia should have their Hb concentration and iron status tested 30 days (or more) before the scheduled surgical date.
Unexplained anaemia should always be considered as secondary to some other process. If possible, elective surgery (especially for non-malignant disease) should be deferred until the anaemia is adequately evaluated and treated.
Why pre-operative anaemia management is important
Patients undergoing elective surgery with pre-operative anaemia are at increased risk of blood transfusion and the risks associated with transfusion. Anaemia itself can lead to worse surgical outcomes (Munoz et al 2017, Peri-operative management of anaemia and iron deficiency, Anaesthesia, 72, 233-47). RBC transfusion is associated with significantly longer stays in hospital and ICU in patients undergoing cardiac and noncardiac surgery. (Perioperative PBM Guideline, 2012). In studies in elective orthopaedic surgical patients, previously undiagnosed anaemia is common and is associated with increased perioperative morbidity and mortality. It increases the likelihood of blood transfusion, which is independently associated with increased morbidity, mortality and hospital length of stay.
Anaemia is defined by the World Health Organization as a Hb level below 120 g/L in females and 130 g/L in males.
Hong et al. (2017) describe iron deficiency as the commonest cause of pre-operative anaemia, accounting for 20–28 per cent of anaemic patients presenting to preadmission clinics.
The aetiology of anaemia should be identified and, if necessary, patients referred for further investigation and treatment before surgery. This may require a delay to surgery and should be discussed with the patient.
Blood conservation strategies
- Prevention of hypothermia (Grade A evidence)
- Australian College of Perianaesthesia Nurses (ACPAN) practice guideline: .
- The Australian College of Perioperative Nursing has a standard on hypothermia, which is accessible to subscribers.
- The National Institute for Health and Clinical Excellence (United Kingdom), guidance: Hypothermia prevention and management in adults having surgery.
- Intraoperative cell salvage (Grade C evidence)
- Using medications (Grade A evidence in cardiac surgery; Grade B evidence in noncardiac surgery for the use of Tranexamic Acid)
Resources to support PBM and help health services develop a PBM program, including templates, checklists and guidance documents.
- Blood Matters 2020 - The guiding principles are intended to assist health services include blood conservation strategies within their clinical practice guidelines.
- Blood Matters 2020 - This report covers the audit of blood sampling practices in Victorian health services to identify opportunities for improving practice to reduce the risk of iatrogenic anaemia.
Reviewed 02 December 2021