Patient Blood Management

Patient Blood Management(PBM) is an evidence-based, multidisciplinary approach to optimising the care of patients who might need a blood transfusion.

Like any other treatment it must involve the patient in the decision to ensure they receive the safest and best care and that inappropriate use of blood
and blood components are avoided.

PBM is part of a national and international initiative in best practice for blood conservation.

National Recommendations for how we should implement Patient Blood Management were issued in 2014.

Why do we need PBM?

Donor blood transfusion is no longer the default option.

Only 4% of the UK population give blood, but around 30% (mostly elderly) will need a blood transfusion at some time in their lives.

The population is getting older, so less people will be eligible to give blood.

Think of blood like oil – increasingly scarce and expensive and more difficult to obtain.

Like alternatives to oil, we must seek alternatives to blood.

Added to this is the fact that donor blood transfusion carries risks as well as benefits.

For increasingly numbers of patients, restrictive blood management can be better than a liberal one. We must only give blood to those patients who will
really benefit from it.

In some areas there is increased demand for blood.

These include upper gastrointestinal bleeding (often alcohol related) – nationally this uses 14% of the total blood supply in the UK.

We are also seeing an increase in blood transfusion for the haematology/oncology patients.

This is because treatments for these specialties are improving all the time, which is good as patients survival increases but sometimes a blood transfusion is the only possible therapy.

Remember too that blood transfusion can save lives, but it is a precious and limited resource and must be used wisely.

If there is absolutely no alternative to a donor blood transfusion for your patient, then please follow the indications and guidelines as displayed in other areas of this Patient Blood Management website.

Please only transfuse if clinically indicated and where possible give blood components unit by unit incrementally, rechecking Hb/coagulation after each unit. A recent audit on upper gastrointestinal bleeding in our Trust demonstrated huge blood wastage – £50,000 could have been saved if blood components had been used more sparingly.

What are the alternatives to donor blood?

There are many and varied methods of avoiding donor blood use, ranging from simple measures such as keeping the patient warm to stabilise their coagulation, through to technical applications, such as cell salvage (recycling patient’s own blood during surgery) and near patient testing devices, for example Hemocues.

 

The Hospital Transfusion Team (HTT)

 The responsibility for implementing PBM and these recommendations rests with the Hospital Transfusion Team which operates on behalf of the Patient Blood Management Group.

The Team is responsible for reviewing and monitoring the Trust’s compliance with national policies and guidelines from a variety of bodies including the Blood Safety and Quality Regulations 2005, reporting to amongst others the Medicines Health Regulatory Authority (MHRA) and Serious Hazards of Transfusion (SHOT)

This group includes the Clinical Lead for Transfusion, the Transfusion Practitioner, Transfusion Manager, Quality Manager and Transfusion Doctor.

 

The Patient Blood Management Group (HTT)

 The HTT reports to the PBMG.  This group is responsible for ensuring the safe, secure and economic use of blood transfusions and blood products and compliance with legislation and best practice. This group meets quarterly and includes clinical and medical representatives from key areas of the Trust involved in blood transfusion. It reports to the Clinical Effectiveness Committee ( CEC)