Blood Management

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blood management diagram

Blood management is the appropriate provision and use of blood, its components and derivatives, and strategies to reduce or avoid the need for a blood transfusion.


What is Blood Management?
Once referred to as bloodless medicine, bloodless surgery or transfusion free medicine, blood management has expanded/evolved into encompassing the appropriate provision and use of blood and blood products while using strategies to reduce or avoid the need for blood transfusion. By doing so, patient outcomes are improved. A multidisciplinary, patient centered approach to minimizing blood transfusions is required.

What is a Blood Management Program?
A blood management program uses a team approach to assess a patient’s blood management needs. The goal of the team is to develop a plan of care that uses the latest drugs, technology and techniques to decrease blood loss and to enhance an individual’s own blood supply. This approach reduces or eliminates the need for a blood transfusion.

What are ways that blood management programs are working toward transfusing less blood?

  • Eliminating preoperative autologous donation; this strategy is cost ineffective and leads to increases in transfusions.
  • Reducing surgical blood loss; this is achieved by combining meticulous surgical methods and drugs to control bleeding and promote clotting and coagulation. Blood salvage can also be extremely useful when applied correctly.
  • Correcting preoperative anemia complications in surgical patients is significantly associated with the presence of preoperative anemia which can be present in up to 50% of a surgical population. Optimizing red blood cells prior to surgery can be achieved by recognizing its mechanism and treating appropriately.
  • Launching a vigorous educational program to highlight the judicious use of blood products to reshape the medical staff's approach to transfusion and prevent unnecessary transfusions.

Why should blood management programs be important to patients?
Central to success is a coordinated approach that encompasses the entire peri-operative period and utilizes all areas of expertise leading to the best possible outcomes.

Effective blood conservation strategies are best implemented early, often at the primary physician level. Many physicians representing a wide range of specialties are committed to using the latest blood management technologies and participate in continuing blood management education activities. These physicians are willing to formulate a plan of care tailored to each patient.

How do I find a doctor who is familiar with blood management techniques?
SABM’s website (www.sabm.org/hospitals) has a listing of most of the Blood Management Programs available in the United States. One can also check to see if their own hospital has a blood management program, then contact the coordinator who can provide further assistance.

What should a patient ask their physician or surgeon prior to surgery regarding transfusions?

  • Will I need a blood transfusion? If so, why?
  • What are the risks if I choose to minimize or avoid blood transfusions?
  • What else do I need to do to prepare myself for surgery?
  • Will I need to increase my blood count for this surgery?
  • What are the risks involved with blood transfusions?
  • If I do need a blood transfusion, how will it affect my recovery time?
  • If my blood count level is low after surgery, how will it affect my ability to resume normal activity?

SABM Patient Information Brochure

Safety of Supply
While the blood supply in the United States is safer than it has ever been, new pathogens (diseases for lay persons) continue to cause concern. For example, the United States blood banking system has only recently started testing for Chagas disease, a fatal and incurable parasitic disease that has been pervasive throughout Central and South America for many years. While it has been in the United States blood supply for many years, only recently have immigration patterns forced testing. Other pathogens could exist and not yet be detected.

Technology
Technology plays an important role both in equipment and drugs that can be employed to reduce the need for transfusions during surgery. For example:

Equipment

Drugs

  • There are drugs that can stimulate the body to make more of its own blood cells. This allows patients to enter surgery healthier and feel better faster.

Transfusions
The transfusion of another person's blood produces immunosuppressant, that is, a decrease in a patient’s immune system function. This is especially undesirable when a patient is ill or has had surgery and is in a hospital surrounded by potential infections.

The transfusion of blood is far from an exact science; it is an area of medicine that even many physicians will admit to not really understanding.

Government Interest
The techniques and information gathered from blood management programs is being used by the military to assist soldiers who may not have blood available or may need drugs that can rapidly stop bleeding. This is also of interest at many levels of the private sector and governmental agencies as they anticipate and prepare for potential terrorist acts.

Shortage of Blood
Less than 5% of the eligible United States population donates blood. Alleviating the strain on uncertain blood inventories is prudent due to a shrinking donor pool and a growing demand by an aging population. Blood shortages are rampant during holidays, storms, cold weather periods, and may cause hospitals to have to postpone or cancel surgeries. With appropriate blood management, blood may not be necessary for many procedures and is conserved for those who really need it.

Costs
It is estimated that 50-60% of blood transfused in the United States is unnecessary. That translates into billions of wasted health care dollars every year in a system that can ill afford waste.