Patient Blood Management: A Six-Point Plan
Our six-point plan optimizes the effectiveness of patient blood management at UPMC by doing the following.
1. Minimization of Iatrogenic Blood Loss
This means we seek to limit blood loss resulting from being admitted to the hospital. In addition, we limit the frequency of blood testing and perform the testing as near to the patient as possible.
This approach allows us to reduce the amount of blood per test.
Amount of blood drawn per test
In the past:
10 to 15 ml
Currently:
1 to 2 ml
The point-of-care testing in our operating rooms and on our patient floors provides the physician with timely results, optimizing the decision process.
2. Use of Autologous Blood Recovery and Biologic Therapy
UPMC 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 risks — but we're doing so at a lower cost. All UPMC blood management sites in western Pennsylvania are AABB accredited for perioperative autologous blood collection and administration.
3. 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 that 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, UPMC has reduced this process by 80 percent through the use of other patient blood management strategies, including autologous blood recovery.
4. 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.
5. 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.
6. Health Care Worker Education and Auditing of Transfusion Practice
Perhaps the most important part of our patient blood management 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.
