PBM: Global standard in healthcare

By Dr. Angelina Apostol-Gapay, FPSA

In 2010, the World Health Organization, through resolution 63.12, encouraged its Member States to adopt Patient Blood Management or PBM. Then, on 19 October 2021, it issued a policy brief, "The Urgent Need to Implement Patient Blood Management," which aims to "create awareness about the enormous, but greatly under-appreciated global disease burden of iron deficiency, anaemia, blood loss, and bleeding disorders."

Sponsored by the Society for the Advancement of Blood Management or SABM, 6-10 November 2023 is "Patient Blood Management Awareness Week." SABM is an organization dedicated to educating patients and healthcare professionals about Patient Blood Management (www.sabm.org).

SABM's definition of PBM is: "The timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss to improve patient outcome." Aryeh Shander, MD, and his colleagues came up with the global definition of PBM: "a patient-centered, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood, while promoting patient safety and empowerment."

They also defined PBM for laypersons as "a patient-centered and organized approach in which the entire health care team coordinates efforts to improve results by managing and preserving a patient's blood. 

The Joint Commission has named blood transfusion one of the most overused hospital procedures.

Although blood transfusion has saved lives in many seriously ill patients, it is also associated with adverse effects. It is an independent risk factor for increased morbidity and mortality in patients. The 2022 Serious Hazards of Transfusion (www.shotuk.org) data show errors, such as incorrect blood component transfused, topping the reports on blood transfusion reactions. Other adverse reactions to donor blood transfusion include fever, allergy and a drop in blood pressure, lung injury, and fluid overload, aside from infections.

Blood is a precious commodity, and its acquisition costs add up to the cost of hospitalization. In the Philippines, the true cost to the healthcare system for a single unit of red cells is unknown. Ensuring blood safety entails complex screening tests and procedures that may only be available in some hospitals. What is not factored into the cost of procuring blood — is hospitalization due to adverse reactions caused by blood transfusions.

Healthcare professionals use techniques, medications, and technology that decrease blood loss and increase the patient's own red blood cell production. This approach reduces or eliminates the need for blood transfusion, thus minimizing the risk of exposure. It also puts the patient at the center of the decision-making process. These modalities improve the patient's well-being and outcome and decrease hospital costs.

The WHO has estimated that nearly one-third of the world's population suffers from anemia. Many times, blood transfusions are used to correct iron-deficiency anemia. However, the most cost-effective way to correct this condition is with iron, oral or intravenous infusion where the oral route is not feasible or not tolerated by the patient, or when surgery cannot wait for complete correction of anemia.

The PBM movement in the Philippines started with leading clinicians and is slowly being recognized by academic societies. However, many healthcare professionals are still skeptical about patients' benefits from PBM implementation. When treating anemia, some healthcare professionals seem stuck in a 20th-century mindset.

By default, rather than what is evidence-based, they transfuse red blood cells. We should take to heart what the published research and studies have shown regarding the benefits of PBM. Changing our medical preconceptions can be difficult, especially if it means adjusting our practice. PBM has forced us to rethink how we treat anemia and bleeding.

Globally, it has become a standard in healthcare.

(Dr. Apostol-Gapay is an anesthesiologist who chairs Divine Word Hospital's Department of Anesthesiology in Tacloban City, Leyte. She is a member of the Professional Wellbeing Committee of the World Federation of Societies of Anaesthesiologists.)