Getting patient blood management Pillar 1 right in the Asia-Pacific: a call for action

Abstract

Preoperative anaemia is common in the Asia-Pacific. Iron deficiency anaemia (IDA) is a risk factor that can be addressed under patient blood management (PBM) Pillar 1, leading to reduced morbidity and mortality. We examined PBM implementation under four different healthcare systems, identified challenges and proposed several measures: (a) Test for anaemia once patients are scheduled for surgery. (b) Inform patients about risks of preoperative anaemia and benefits of treatment. (c) Treat IDA and replenish iron stores before surgery, using intravenous iron when oral treatment is ineffective, not tolerated or when rapid iron replenishment is needed; transfusion should not be the default management. (d) Harness support from multiple medical disciplines and relevant bodies to promote PBM implementation. (e) Demonstrate better outcomes and cost savings from reduced mortality and morbidity. Although PBM implementation may seem complex and daunting, it is feasible to start small. Implementing PBM Pillar 1, particularly in preoperative patients, is a sensible first step regardless of the healthcare setting.

Keywords: Asia Pacific; anaemia; iron deficiency; patient blood management; preoperative.

Fig. 1

Chart shows proposed algorithm to evaluate and treat perioperative anaemia. *If TSAT is unavailable, assess clinical context for conditions that may falsely elevate ferritin despite ID. †If ferritin is > 100 μg/L, TSAT < 20% is required to support diagnosis of IDA. If anaemia cannot be classified based on these, contact a haematologist. CRP: C-reactive protein; eGFR: estimated glomerular filtration rate; EPO: erythropoietin; F: female; Hb: haemoglobin; ID: iron deficiency; IDA: iron deficiency anaemia; IV: intravenous; M: male; TSAT: transferrin saturation