Patient blood management can alleviate ongoing stresses of blood shortages

The topic of blood always seems to be in the headlines of both industry and consumer news. Recently, it has been around shortages and inadequate supplies for ongoing care — a deficit that’s only worsened with climate change and recent natural disasters. 

While we recognize and appreciate the generous efforts and intent of those who donate blood to supply to others, we must find innovative ways to manage the demand side of the equation, by optimizing, protecting, and preserving our patients’ own blood. By reducing the modifiable risks of bleeding and anemia, we reduce the number of times transfusion is even considered. 

Undoubtedly, everyone working in the hospital setting wants to ensure the best possible outcome for each patient. Healthcare is personal, and we all want to be successful for ourselves, our patients, and our institutions — clinically, ethically, and financially. Traditionally, this quality care often included the assumption that blood for transfusion was readily available, used only when necessary, and with fiscal responsibility. Unfortunately, this is not the case in our modern healthcare settings. 

Enter patient blood management (PBM), a multidisciplinary, data-driven approach to conserving the patient’s own blood. It is becoming increasingly understood that transfusing blood products might not always be helpful, and in almost all cases, relying on and enhancing the health of the patient’s own blood is a better approach. Fundamentally, it makes sense to safeguard the patient’s own blood to help them recover versus introducing another individual’s blood to the patient. 

With an aging population and increasing rate of natural and human-made disasters and traumatic events, there is no way that the supply of donor blood can keep up with demand, unless there is a change to the way clinicians order and use this resource. Additionally, since only 3% of the eligible U.S. population donates blood, we are obliged to develop better ways to navigate these shortages.¹ 

PBM initiatives are not new 

For the better part of a decade, hospital systems in many countries throughout the world have a proven return on investment with PBM programs. Beyond reducing the direct cost associated with the acquisition of blood components, there are significant clinical benefits to conserving blood, which in turn has a direct financial advantage. Lower demand equals less investment in blood. 

Perhaps the most important public health organization, the World Health Organization (WHO), took the extraordinary step of issuing a policy brief on the topic and implored clinicians and organizations to understand the importance of proper conservation of blood and its impact.² Globally, there are 2.1 billion individuals living with anemia and as many as 600 million patients dealing with bleeding problems. The global importance of patient blood management is more than episodic. We need to change the long-standing but non-evidence-based thinking behind the traditional way of ordering blood transfusions and create new protocols that support the protection and conservation of our patients’ own circulating blood. 

The important role of diagnostics

We are increasingly mindful of how best to manage trauma events and cardiac, obstetric, and thoracic surgery patient populations, which are typically the medical specialties in which external blood component support is indicated. Clinical initiatives are important, but moving the needle requires providing the right information at the right time to help ensure the best choices are made for the future success of the patient. 

Hemostasis testing that is able to predict how a patient’s blood will clot is critical to determine if blood components are truly clinically indicated. Traditionally, this testing would require samples to be processed in a hospital's lab, which could take 30–90 minutes. In reality, this isn’t helpful when the patient’s status is critical and in a surgical environment. The seemingly “safest” decision for the surgical team has often been to order blood for transfusion, however, this puts the patient at risk for allergic reactions, blood-borne infections, fever, and acute immune hemolytic reactions, while also leading to increased morbidity and mortality.³

There are emerging point-of-care (POC) viscoelastic testing solutions⁴ that provide clinicians with critical information needed to quickly and accurately guide treatment decisions. By having this information in real-time, hospitals are seeing the true impact of implementing PBM programs. There is decreased utilization of blood components, fewer postoperative patient complications, and of course, improved financial outcomes.

PBM programs are gaining traction across the United States but like most initiatives, it takes education and collaboration amongst many key players in the hospital environment to launch a successful program. POC testing plays a role, and I’m hopeful that in 2025 we’ll be smarter and wiser with our blood conservation, which will only lead to greater progress in the years and decades ahead. 

REFERENCES

1. Groups release updated statistics on U.S. blood donation, use. American Hospital Association | AHA News. Accessed December 9, 2024. https://www.aha.org/news/headline/2024-01-29-groups-release-updated-statistics-us-blood-donation-use.
2. The urgent need to implement patient blood management: policy brief. Who.int. October 19, 2021. Accessed December 9, 2024. https://www.who.int/publications/i/item/9789240035744.
3. Risks and complications. Redcrossblood.org. Accessed December 9, 2024. https://www.redcrossblood.org/donate-blood/blood-donation-process/what-happens-to-donated-blood/blood-transfusions/risks-complications.html.
4. ROTEM sigma coagulation testing. Werfen.com. Accessed December 9, 2024. https://www.werfen.com/na/en/coagulation-testing-rotem-sigma.