Patient Blood Management
Patient Blood Management is a patient-centered, evidence-based approach to utilizing a rare and limited resource, blood. As such, patient blood management seeks to eliminate unnecessary blood transfusions. To optimize the effectiveness of the program, we have focused on a six-point plan:
- Minimization of iatrogenic blood loss. This means we seek to limit blood loss resulting from being admitted to the hospital. As an example, in the past we used 10 to15 ml of blood per test, and now we have reduced that amount to 1 to 2 ml. In addition, we limit the frequency of testing and perform the testing as near to the patient as possible. The point-of-care testing provides the physician with timely results, optimizing the decision process.
- Use of autologous blood recovery and biologic therapy. As previously described, this program is actively saving blood during many surgical procedures where blood loss is anticipated. Not only are we returning the patient’s own blood, reducing transfusion related risk but we do so at a lower cost. We are also proud that UPMC has 12 of the 22 AABB accredited blood recovery programs in the world.
- Elimination of preoperative autologous donated blood. Previously, in response to blood transfusion-transmitted viruses, surgeons recommended their patients donate their own blood before the operation. Subsequent studies have shown this practice has limited clinical benefit and may actually cause a greater transfusion rate because it lowers the patient’s blood count. Over the past five years we have reduced this process by 80 percent through the use autologous blood recovery.
- Use of strict transfusion triggers. All blood products are transfused when the patient’s lab values fall below a threshold. We have carefully analyzed our practice and now employ evidence-based triggers that safely identify the best time to transfuse blood. Using these triggers has markedly reduced the frequency of transfusion and the associated complications.
- Anemia management. All surgical patients have their preoperative blood count checked to determine the concentration of red blood cells. If that level falls below our threshold, we offer additional testing to determine the cause and correct the situation before going to surgery.
- Health care worker education and auditing of transfusion practice. Perhaps the most important part of our plan is education. UPMC has committed to this process from the top on down. We have transfusion committees at every hospital and provide transfusion data to all surgeons. Performance indicators are selected based on scientific literature, and we seek to meet the highest level of performance possible.
What is the relationship between UPMC’s Patient Blood Management program and the recently instituted Center for Bloodless Medicine and Surgery at UPMC?
As an integral part of the Patient Blood Management Program the bloodless medicine program treats patients who refuse transfusions with dignity and respect. Bloodless medicine and surgery involves the same principles as PBM with the only difference being that for these patients transfusion is not a last resort—it is not an option at all.
Bloodless medicine patients will benefit by our efforts to reduce transfusions throughout the system. The PBM committee may provide guidance to the bloodless medicine program and to the medical staff who treat bloodless medicine patients. In turn our efforts to reduce transfusions throughout UPMC are rewarded when treating patients who refuse blood transfusions.