Patient Blood Management: An Internist's Perspective

Abstract

Patient blood management (PBM) is a patient-specific, evidencebased and systematic approach to optimize the management of patient and blood transfusion for quality and effective patient care. It aims at improving patient outcomes through the rational and safe use of blood products and minimizing unnecessary exposure to it [1]. The concept of PBM is not only “blood conservation” but also “blood management” which includes the preventive approaches to maintain and optimize hemoglobin (Hb) level and hemostasis [2]. The goal of PBM is not merely to avoid or withhold transfusions, but to timely apply evidence-based medical and surgical concepts designed to manage anemia, optimize hemostasis, and minimize blood loss to improve patient outcomes by relying on a patient’s own blood rather than on donor blood [2,3]. The concept of PBM is well established in surgical patients, demonstrating significant reductions in blood usage, yet with improved patient outcomes and reduced cost [4]. However, 52%–65% of recipients of allogeneic blood transfusion are medical patients with hematologic and non-hematologic malignancies, acute gastrointestinal bleed, renal failure, and other chronic disorders, etc [5]. In contrast to surgical patients, PBM is less developed in medical patients, in particular with hematologic/oncologic diseases, by whom a significant percentage of the blood is consumed [3,5]. This review will discuss how to integrate the concept of PBM into medical conditions including acute coronary syndrome (ACS), heart failure, chronic kidney disease (CKD), chemotherapy-induced anemia (CIA), and hematologic malignancies, in the aspect of red blood cell (RBC). Review