Building A Patient Blood Management Program in A Large-Volume Tertiary Hospital Setting: Problems and Solutions

Successful implementation of a patient blood management program necessitates the collaboration of a strong organization and a multidisciplinary approach. We organized a meeting with broad participation in our center to establish a consensus for implementation of a specific patient blood management program. International and domestic experiences were shared, the importance of coordination and execution of different pillars in patient blood management were discussed, and the problems about the blood transfusion system were also investigated with the proposal for solutions. The data obtained from this meeting are presented to be a guide for similar large-volume tertiary hospitals for integration of a patient blood management protocol.

The World Health Organization (WHO) described the patient blood management (PBM) in the early 2000s, which was made effective in the Netherlands for the first time. In 2008, Australia was the first country which made it compulsory nationwide. The United States, in 2007, published a guideline on bleeding and blood management before and after cardiac surgery. The criticism and suggestions were considered for four years and were used to reform the guideline in 2011. The European PBM guideline was published in 2017, and the Turkish guideline was published in 2019. Numerous studies conducted in these countries endorsed 30 to 40% reduction in the number of blood transfusions, significant resource savings, and a significant reduction in morbidity and mortality of patients.The PBM is a three-pillar strategy to cure preoperative anemia and iron deficiency (intravenous [IV] iron + erythropoietin [EPO] + vitamin B12 + folic acid), reduce preoperative red blood cell (RBC) loss by an improved surgical technique, cell salvage, and re-transfusion, acute normovolemic hemodilution, coagulopathy management (anti-fibrinolytics, fibrinogen, Factor XIII, prothrombin complex concentrate [PCC], low central venous pressure, no hypertension, normothermia), and optimize anemia management (tolerate low hemoglobin values, IV iron + EPO postoperatively, increased fraction of inspired oxygen [FiO₂]).[8–13]

In this review, we aimed to share previous experiences and indicate current problems with solutions which would ensure the implementation of a PBM protocol in our hospital that can be also a guide for similar large-volume tertiary hospitals.