Outcomes, cost-effectiveness, and ethics in patient blood management.

Purpose of the review: In this narrative review, we evaluate the recent evidence for benefits, cost-effectiveness, and ethical considerations of patient blood management (PBM) programs.

Recent findings: PBM programs are able to reduce the amount of red blood cell transfusion by 20-40% and the risk of reoperation. Lower morbidity and mortality due to PBM implementation were only shown in retrospective studies with a before-and-after design but not in randomized controlled trials. PBM is very likely to be cost-effective when reduced blood transfusion can be accomplished through low-cost interventions, such as administration of oral iron or antifibrinolytics. Further, cost-efficacy can also be achieved by reducing postoperative morbidity and length of hospital stay. Of note, cost-efficacy of PBM interventions might be better in patients at high bleeding risk. Finally, aiming to improve patient's outcome while minimizing transfusion-induced complications, PBM seems highly ethical.

Summary: PBM is an important concept as it promotes the rational use of allogeneic blood products and reduces transfusion and wastage of precious and limited blood products.