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<\/p>\nBy implementing patient-centered blood management, far-reaching medical and economic benefits can be achieved. This is shown by numerous scientific analyses. The evidence-based approach recommended by the WHO aims at rational use of blood products by strengthening the body’s own blood. The internationally renowned expert Prof. Dr. rer. medic. Axel Hofmann presented a webinar on what the 21st century challenges are in healthcare and how PBM can help mitigate the crisis.<\/p>\n
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(mp) Clarification and treatment of preoperative anemia prior to elective surgery as well as more restrictive transfusion behavior are key measures in the context of patient blood management (Fig. 1). This can result in reductions in blood transfusions, reduced complication rates, and shorter hospital stays, all of which are beneficial to quality of care, cost efficiency, and security of supply for blood products [1\u20133]. This was demonstrated by Prof. Dr. rer. medic. Axel Hofmann in the webinar on “Patient Blood Management – Why should I introduce the concept in my hospital?” in an impressive way [4]. Professor Hofmann is, among other things, chairman of a working group that is developing international guidelines for the implementation of this concept on behalf of the WHO. According to the WHO, demographic change, declining blood donations and excessive use of blood products will lead to worldwide shortages from 2030 onwards, and this is already becoming apparent in Switzerland [5\u20137]. PBM measures have been shown to improve the safety of blood product supplies and improve several other outcomes. Patients as well as hospitals and the healthcare system as a whole benefit from this, so that this program now occupies a leading place in health policy agendas worldwide. The Swiss Society of Anesthesiology and Resuscitation (SGAR) has included a restrictive approach to red blood cell concentrate transfusions in its top 5 list of “Choosing Wisely” initiatives [24].<\/p>\n
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Source: Vifor Pharma<\/span><\/p>\n Innovative method for improving the quality of healthcare <\/strong><\/p>\n In the context of demographic change and the changing age structure of society, it is necessary for healthcare systems to adapt. “Medicine of the future will focus more on efficient use of resources,” Professor Hofmann summarizes a key message of an article published in the New England Journal of Medicine [4,8]. A long-term study by McKinsey & Company on the development of productivity* of various economic sectors shows that the healthcare sector performs comparatively poorly [9]. Innovative methods are needed that contribute to improvement in the following three dimensions: quality of care and patient satisfaction, public health, and health care cost reduction. In the Global Health Expenditure Atlas, the WHO stated that around 20-40% of health care costs are due to wasteful use of resources [10]. Among the suboptimal processes contributing to this is a triad of anemia\/iron deficiency, blood transfusions, and an associated increased risk of blood loss, Prof. Hofmann said. He explains that approximately 57% of patients treated perioperatively are anemic [11]. In Switzerland, the prevalence of preoperative anemia in knee and hip surgery is 25-45% [12]. In patients with preoperative anemia, the risk of transfusion is 3.9 times higher. This is associated with 22% longer hospital stays and a higher risk of infection, a greater risk of acute renal failure, and a 2.9 times higher risk of mortality [13\u201315]. This is where the multidimensional concept of patient blood management comes in, which has been shown to improve quality of care as well as various health economic indicators [2].<\/p>\n *Productivity = Output: Input<\/span><\/p>\n **From the time of hospital admission to the time of hospital discharge.<\/span><\/p>\n What are the three pillars of patient blood management? <\/span><\/strong><\/p>\n Fig. 1: Patient Blood Management <\/strong><\/p>\n Source: according to [26,27]<\/span><\/p>\n <\/p>\n To the webinar: “Patient Blood Management (PBM) – why should I introduce this concept in my hospital?”,<\/a> Prof. Dr. med. A. Hofmann<\/span><\/strong><\/span><\/p>\n <\/p>\n <\/p>\n Literature:<\/strong><\/span><\/p>\n\n
\n Optimization of red blood cell volume: <\/span>
\n<\/strong>Preoperative anemia not only increases transfusion requirements – it is also associated with increased morbidity and mortality [14]. Correction of preoperative anemia and iron deficiency significantly reduces the transfusion rate , leads to improved postoperative recovery and thus to faster mobilization and shorter patient hospitalization time [16\u201318]. Therefore, the first step to patient-centered blood management is to detect, screen for, and treat anemia that exists preoperatively [19]. A meta-analysis with data from a total of 949 449 patients from 24 studies concluded that 39% of patients had preoperative anemia according to the WHO definition with associated unfavorable impacts on mortality and morbidity [15]. Those over 65 years of age are particularly likely to receive a red blood cell transfusion [20]. In the study of 8 744 people in this age group, the prevalence of anemia was 11.8% [21]. International guidelines recommend that elective surgery with a transfusion risk \u226510% (or a blood loss of >500 mL) should be assessed for anemia and treated before surgery [22,23]. <\/p>\n
\n Minimizing blood loss and transfusion.<\/span>
\n<\/strong>: <\/span>“Anemia is bad, transfusion does not lead to improvement,” Professor Hofmann said. One study showed that in mild anemia preceding noncardiac surgical procedures, the odds ratio (OR) for mortality was 1.4 (1.3-1.5) and for morbidity was 1.3 (1.3-1.4). Blood transfusion worsened this outcome: mortality OR 2.0 (1.8-2.2), morbidity OR 1.8 (1.7-1.9) [13]. Intraoperative and postoperative blood loss is an independent predictor of increased perioperative morbidity and mortality, which are not reduced but increased by transfusion of blood components [25]. Therefore, after preoperative control and, if necessary, optimization of the erythrocyte volume, the preservation of this volume is in the foreground. Options for minimizing blood loss range from careful surgical hemostasis to classic foreign-blood-sparing procedures to the use of hemostasis-supportive drug preparations [19].<\/p>\n
\n Optimization of individual anemia tolerance: <\/span>
\n<\/strong>Preoperatively, patients’ physiologic reserve for blood loss\/anemia should be assessed and tolerable blood loss calculated. Intraoperatively, the focus is on establishing or maintaining normovolemia as well as individualized anesthesiological-intensive therapeutic measures to increase anemia tolerance (especially optimization of cardiac output, optimization of ventilation, reduction of oxygen consumption) [27]. Postoperatively, general measures such as maintenance of normovolemia, pain therapy and further treatment\/avoidance of secondary diseases, control of iron status and, if necessary, correction by iron substitution or optimization of erythropoiesis must be performed [27].<\/p>\n![\"\"](\"https:\/\/medizinonline.com\/wp-content\/uploads\/2021\/11\/bildschirmfoto_2021-11-15_um_11.37.57.png\")
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\n Vifor Pharma Switzerland<\/span>
\n<\/strong> supports and accompanies Swiss hospitals on their way to implement the concept of PBM(www.viforpharma.ch)<\/strong>. Contact us<\/a> for more information.<\/span><\/span><\/p>\n1 Kaserer J, et al: Impact of a Patient Blood Management monitoring and feedback programme on allogeneic blood transfusions and related costs. Anaesthesia 2019, doi:10.1111\/anae.14816<\/span><\/div>\n2. Leahy MF, et al: Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals. Transfusion 2017; 57(6): 1347-1358.<\/span><\/div>\nMeybohm P, et al: Patient Blood Management is Associated With a Substantial Reduction of Red Blood Cell Utilization and Safe for Patient’s Outcome: A Prospective, Multicenter Cohort Study With a Noninferiority Design. Ann Surg 2016; 264(2): 203-211.<\/span><\/div>\n4. Hofmann A: “Patient Blood Management (PBM) – why should I introduce this concept in my hospital?”, Prof. Dr. med. Axel Hofmann, Forum for Continuing Medical Education (FomF), WebUp, 24.08.2021 <\/span><\/div>\n5 Greinacher A, Fendrich K, Hoffmann W: Demographic Changes: The Impact for Safe Blood Supply. Transfus Med Hemother 2010; 37(3): 141-148.<\/span><\/div>\n6. WHO resolution WHA63.12. Availability, safety and quality of blood products. Add WHO 2021 The urgent need to implement patient blood management<\/span><\/div>\n7 Volken T, et al: Red blood cell use in Switzerland: trends and demographic challenges. Blood transfusion 2016; 16(1): 73-82.<\/span><\/div>\n8. Kohane IS, Drazen JM, Campion EW: A glimpse of the next 100 years in medicine. N Engl J Med 2012; 367(26): 2538-2539.<\/span><\/div>\n9. McKinsey & Company, Inc: Bureau of Economic Analysis, Centers for Medicare and Medicaid Services, Haver Analytics. <\/span><\/div>\n10th WHO Global Health Expenditure Atlas, World Health Organization (WHO), September 2014.<\/span><\/div>\n11. Krishnasivam D, et al: Anemia in hospitalized patients: an overlooked risk in medical care. Transfusion 2018; 58(11): 2522-2528.<\/span><\/div>\n12 Spahn DR: Anemia and patient blood management in hip and knee surgery: a systematic review of the literature. Anesthesiology 2010; 113: 482-495.<\/span><\/div>\n13 Musallam KM, et al: Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet 2011; 378(9800): 1396-1407.<\/span><\/div>\n14 Beattie WS, et al: Risk associated with preoperative anemia in noncardiac surgery: a single-center cohort study. Anesthesiology 2009; 110(3): 574-581.<\/span><\/div>\n15 Fowler AJ, et al: Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg 2015; 102(11): 1314-1324.<\/span><\/div>\n16 Myers E, Grady PO, Dolan AM: The influence of preclinical anemia on outcome following total hip replacement. Arch OrthopTraumaSurg 2004; 124: 699-701.<\/span><\/div>\n17 Lawrence VA, et al: Higher Hb level is associated with better early functional recovery after hip fracture repair. Transfusion 2003; 43: 1717-1722.<\/span><\/div>\n18. Kotz\u00e9 A, et al: Effect of a patient blood management programme on preoperative anaemia, transfusion rate, and outcome after primary hip or knee arthroplasty: a quality improvement cycle. Br J Anaest 2012; 108: 943-952. <\/span><\/div>\n19 Schlegel E, Biscoping J: Patient Blood Management – From Blood Product to Individual Therapy. Anesth Intensivmed 2014; 55: 498-509, https:\/\/www.ai-online.info\/,<\/a> last accessed 09.11.2021. <\/span><\/div>\n20 Borkent-Raven BA, et al: The PROTON study: profiles of blood product transfusion recipients in the Netherlands. Vox Sanguinis 2010; 99: 54-64. <\/span><\/div>\n21 Tettamanti M, et al: Prevalence, incidence and types of mild anemia in the elderly: the “Health and Anemia” population-based study. Haematologica 2010; 95: 1849-1856. <\/span><\/div>\n22. Harms C, Metzger R, Bhend H: Improving patient outcome through rational use of blood products: “Patient Blood Management at the Small Hospital”. Swiss Med Forum 2020; 20(2326): 355-361. <\/span><\/div>\n22 Meybohm P, et al: Simplified International Recommendations for the Implementation of Patient Blood Management (SIR4PBM). Perioper Med 2017; 6: 5.<\/span><\/div>\n23 Smartermedicine, Choosing Wisely Switzerland, https:\/\/www.smartermedicine.ch\/de\/top-5-listen\/anaesthesiologie-und-reanimation.html, last accessed 09.11.21.<\/span><\/div>\n