Treatments and tests

Patient blood management

About patient blood management

Patient blood management (PBM) is a standard of care in medicine and surgery which seeks to maximise the use of a patient’s own blood and avoid unnecessary blood transfusions during surgery.

Research from around the world shows that patients recover sooner, heal faster and have less complications when they rely upon their own blood supply during surgery, rather than ‘foreign’ blood. 

By planning ahead, PBM helps to reduce your blood being wasted during surgery or medical treatments which have a known risk of blood loss. 

How does PBM work in practice?

PBM involves three basic principles:

Optimise a patient’s blood levels before a surgical or medical treatment

  • Assist the body to be its own blood bank four  to six weeks before surgery.
  • Identify and treat anaemia (low blood levels of haemoglobin).
  • Identify and treat iron deficiency (low iron levels).
  • Identify any coagulation (clotting) abnormalities needing correction or management.

Minimise blood loss during the treatment

  • Certain medications, including some natural medicines and herbal and vitamin preparations, can increase bleeding or clotting at the time of a procedure. These may need to be stopped anywhere from a few days to a number of weeks before a procedure.
  • Some underlying diseases can interfere with the blood’s ability to clot. This may increase bleeding during a procedure and therefore may require treatment ahead of time.
  • Advanced as well as established surgical tools and techniques can be used to reduce bleeding.
  • Use a number of anaesthetic techniques, such as controlling blood pressure, maintaining normal body temperature, and collecting and recycling the patient’s own blood during and after the procedure.
  • Provide medications that reduce bleeding.
  • Take smaller and less frequent samples of blood for tests. 

Optimise recovery

  • A number of non-blood fluids are available to restore blood volume immediately after blood loss.
  • With good management, the body can tolerate lower blood levels than previously thought, without the need for a blood transfusion.
  • Blood-building medications and nutritional support can help the body make its new blood more rapidly. 

When these principles are applied in a coordinated team approach, the majority of elective procedures can be performed without blood transfusion, resulting in better outcomes for patients.

What are the risks of blood transfusion?

Allergic and immunological complications

Because our body is programmed to react when something foreign enters it, doctors now consider alternative treatments before procedures such as organ transplants because of the increased risk of complications. Experts are now suggesting a similar approach with the use of blood – the safest blood is your own. 

Storage-related complications

Once blood has been removed from the body it undergoes chemical and physical changes. Some studies have shown that transfusion of older blood may have a negative effect on some patients. 

Risk of infection

Although all blood donated by the public is carefully screened and tested, there is still an extremely low chance that blood transfusions can transmit infectious bacteria, viruses and parasites. This is due to the possibility of new infections entering the population and our blood supply before tests that identify these infections can be developed.

Blood can also contain tiny amounts of skin bacteria while being collected from the donor. This can result in serious complications for the patient, however this risk has been largely reduced through improved collection and storage techniques.

Why PBM is good for the blood supply

  • Stocks of donated blood can sometimes be very low. PBM can drastically reduce demand on already stretched blood supplies
  • The age group of potential donors is shrinking while the age group that uses the most blood is increasing.
  • Cautious screening and testing for potential infections increases the number of improper donors and dramatically increases the cost of blood.
  • Blood collection, distribution and administration costs are increasing.
  • It is becoming more of a challenge to maintain an adequate and safe blood supply. 

As the population ages these challenges will grow.

More information

Your doctor can explain transfusion risks, benefits and alternatives.

As a patient you have the right to participate in the decision-making process regarding your treatment and care and it is important that you discuss with your doctor any questions or concerns.

Before your doctor commences a treatment and care plan you will need to provide ‘informed consent’, making it important that you understand the process. If you have any questions, concerns or objections it is very important that you discuss them with your doctor.


Acknowledgements

WA Patient Blood Management Program


This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.

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