A Paradigm Shift: Perioperative Iron and Erythropoietin Therapy for Patient Blood Management

The idea of Patient Blood Management (PBM) has emerged mainly due to problems caused by blood transfusion and perioperative anemia. This concept is based on the 5 elements suggested by Hofmann et al. [1] (2011): gaps between supply and demand for blood, high transfusion costs, risk of contaminated blood products, adverse outcomes of transfusion, and a paucity of evidence to prove transfusions efficacy. Furthermore, there is a serious issue related to perioperative anemia. The significance of managing perioperative anemia is particularly underestimated, and medical professionals use blood transfusions indiscriminately to rapidly return hemoglobin (Hb) levels to normal [2,3]. PBM is a group of multi-disciplinary protocols under the concept of 3 pillars that are applied to a patient’s clinical course (before, during and after the operation): optimizing red blood cells (RBCs) production, reducing bleeding, and harnessing the tolerance of anemia [1,4]. One of the advantages of PBM is cost-effectiveness. The Department of Health in Western Australia started comprehensive PBM; they experienced cost savings of Australian dollar (AUD) Review