Perioperative Blood Management
Allogeneic Blood Transfusion (blood donated by a compatible donor) is one of the most common therapeutic interventions in managing perioperative and surgical blood loss. However, since 2008 the National Blood Collection and Utilization Survey (NBCUS) has recorded the decline in blood transfusions. Blood collection declined by 11.6% while transfusions declined by 13.9% between 2013 and 2015. This decline has been attributed to the evidence-based clinical tool called Patient Blood Management (PBM). PBM is “the timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis and minimize blood loss in an effort to improve patient outcome”. This clinical tool has been particularly useful in perioperative care.
Peri-operative care refers to the clinical care of patients before, during and after a surgical procedure. Perioperative blood management or the management of bleeding in surgical patients encourages a restriction in the allogeneic blood transfusion approach. The advantages of perioperative (BM) are linked to hospital cost-reduction due to the reduced hospital stays and the avoided potential complications associated with allogeneic blood transfusion. Some of these blood transfusion complications include an “increased susceptibility to transmissions of infections, transfusion reactions, altered immune response, circulatory overload, transfusion related acute lung injury”.
Perioperative Blood Management Applications
Anaemia has been identified as an independent risk factor in surgical patients’ bleeding. In cardiac surgery patients, anaemia has been linked to greater complications and poor patient outcome. During the pre-operative period (before surgery), perioperative blood management can be employed to diagnose and treat anaemic patients way before surgery thereby reducing the risks of excessive loss of blood. However, despite this finding, diagnosis and treatment of anaemia preoperatively has been suboptimal.
During the intraoperative period (during surgery), perioperative strategies are aimed at reducing bleeding and/or the collection and reinfusing of the patient’s own blood. One of the techniques used to reduce blood loss is the positioning of the patient during surgery. When a patient is incorrectly positioned this could disrupt the return of blood to the heart. In addition, during neck and head surgery, twisting the neck could also interrupt the flow of blood which may cause blood accumulation at the surgical site.
Cell salvage is another intraoperative technique that is used when large blood loss is anticipated. This technique involves the collection of shed blood, processing it and transfusing it back into the patient during surgery. Salvaged red blood cells have been shown to be superior or equal to allogeneic blood when it comes to the survival of the cells.
Lastly, bleeding may continue during the postoperative period (after surgery). Some of the strategies used to manage bleeding include postoperative cell salvage, however this is restricted to elective surgeries. Anaemic patients continue to be monitored as well.
Perioperative blood management strategies involve complex processes and over 100 measures to date. The system is centred on the patient’s journey through the perioperative process and it is a collaborative effort among the different clinicians attending to the patient. Thus patients are encouraged to gain as much information as they can on the different strategies and measures in perioperative blood management, as well as to liaise with their healthcare staff throughout the whole process.
Blood transfusions are a common hospital procedure in bleeding surgical patients.
Perioperative blood management is an evidence-based clinical tool that is designed to assess, monitor and respond to patient bleeding during surgery.
Patients need to collaborate with their healthcare service providers before surgery in-order to prepare well for possible complications during and after surgery and their preferred approaches in handling them.