Patient Blood Management Program Implementation: Comprehensive Recommendations and Practical Strategies

Abstract

Introduction: Blood transfusion is one of the most common medical practices worldwide. However, current scientific literature has shown that the immunomodulatory effects of blood transfusion are associated with an increased likelihood of infection, prolonged hospitalization, and morbimortality. Also, it means high costs for healthcare systems.

Methods: In this context, acknowledging that blood transfusions are essentially heterologous cell transplantations, the use of therapeutic options has gained strength and is collectively known as the patient blood management (PBM) program. PBM is an approach based on three main pillars: (1) treating anemias and coagulopathies in an optimized manner, especially in the preoperative period; (2) optimizing perioperative hemostasis and the use of blood recovery systems to avoid the loss of the patient's blood; (3) anemia tolerance, with improved oxygen delivery and reduced oxygen demand, particularly in the postoperative period.

Results: Current scientific evidence supports the effectiveness of PBM by reducing the need for blood transfusions, decreasing associated complications, and promoting more efficient and safer blood management. Thus, PBM not only improves clinical outcomes for patients but also contributes to the economic sustainability of healthcare systems.

Conclusion: The aim of this review was to summarize PBM strategies in a comprehensive, evidence-based approach through a systematic and structured model for PBM implementation in tertiary hospitals. The recommendations proposed herein are from researchers and experts of a high-complexity university hospital in the network of the Sistema Único de Saúde, presenting itself as a strategy that can be followed as a guideline for PBM implementation in other settings.

Keywords: Blood Transfusion; Costs and Cost Analysis; Guideline; Health Strategies; Hospitalization; Public Health; Research Personnel; Tertiary Care Centers.

Fig. 1

Simplified scheme of the Pharmacological Treatment of Anemia Protocol and Guidelines for Erythropoietin Therapy. EPO=erythropoietin; Hb=hemoglobin; IV=intravenous; SC=subcutaneous.

Fig. 2

Simplified scheme of the Bleeding Management Protocol. Algorithm for persistent bleeding. ACT=activated clothing time; CPB=cardiopulmonary bypass; INR=International Normalized Ratio; ISS=Injury Severity Score; IV=intravenous; PTT=partial thromboplastin time.

Fig. 3

This diagram outlines the step-by-step implementation plan for the patient blood management (PBM).