Transfusion and Apheresis Science 50 (2014) 3–4
Contents lists available at ScienceDirect
Transfusion and Apheresis Science journal homepage: www.elsevier.com/locate/transci
Editorial
PBM symposium introduction
The Society for Advancement of Blood Management (SABM) defines patient blood management (PBM) as 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 [1]. Goodnough and Shander elaborate that blood management is most successful when multidisciplinary proactive programs are in place so that these strategies can be individualized to specific patients [2]. Patient blood management may thus include diagnosis and treatment of perioperative anemia, good surgical technique, topical and systemic hemostatic therapy, and avoidance of unnecessary transfusions among others. The arguments in support of PBM are numerous. Anemia in preoperative patients is common [3] and is predictive of requirement for allogeneic blood transfusion in the perioperative period [4]. Allogeneic blood transfusion may lead to serious complications such as circulatory overload, hemolysis or transfusion related lung injury. Transfusion of allogeneic blood in perioperative setting is also associated with increased duration of hospital stay, infections and mortality [4,5]. When costs associated with production, testing, transfusion as well as management of adverse events, are factored in, the total cost of a single transfused red blood cell unit exceeds 1000 dollars US [6]. PBM respects patient’s autonomy by offering patients a choice, an alternative to transfusion. A growing body of evidence shows that various PBM modalities are safe and effective in reducing the need for allogeneic blood transfusion. Finally, at the core of every PBM program is commitment to patient safety and improvement in quality of care. And yet PBM is not widely embraced, and the reasons for that are also many. Perhaps, one of the explanations is a peculiarity of the Canadian blood system where blood products are provided free to the hospital and yet the hospital is largely responsible for the costs associated with a PBM program. From the transmissible diseases point of view, allogeneic blood is very safe, with risk of HIV
http://dx.doi.org/10.1016/j.transci.2013.12.002 1473-0502/Ó 2014 Elsevier Ltd. All rights reserved.
transmission being estimated at 1 in 7.8 million [7]. Yet another reason may be the lack of awareness of PBM or its benefits. Perhaps, some also may feel that the risks of PBM have not been well documented yet. This symposium will address a few topical questions in PBM including the deleterious effects of anemia, role of erythropoiesis stimulating agents in management of perioperative anemia, and usage of topical hemostatic agents in cardiovascular surgery. The symposium will also feature reports of the two very successful PBM programs, one from the United States and one from Canada. Ultimately, we hope to raise the profile of PBM and engage in discussion all stakeholders – healthcare professionals, hospital administrators, industry, government and of course patients. Disclosures None. References [1] Society for Advancement of Blood Management (SABM) website [accessed 24.12.12]. [2] Goodnough LT, Shander A. Blood management. Arch Pathol Lab Med 2007;131(5):695–701. [3] Beris P, Muñoz M, García-Erce JA, Thomas D, Maniatis A, Van der Linden P. Perioperative anaemia management: consensus statement on the role of intravenous iron. Br J Anaesth 2008;100(5):599–604. [4] Freedman J, Luke K, Escobar M, Vernich L, Chiavetta JA. Experience of a network of transfusion coordinators for blood conservation (Ontario Transfusion Coordinators [ONTraC]). Transfusion 2008;48(2):237–50. [5] Jakobsen CJ, Ryhammer PK, Tang M, Andreasen JJ, Mortensen PE. Transfusion of blood during cardiac surgery is associated with higher long-term mortality in low-risk patients. Eur J Cardiothorac Surg 2012;42(1):114–20. [6] Shander A, Hofmann A, Ozawa S, Theusinger OM, Gombotz H, Spahn DR. Activity-based costs of blood transfusions in surgical patients at four hospitals. Transfusion 2010;50(4):753–65. [7] O’Brien SF, Yi QL, Fan W, Scalia V, Fearon MA, Allain JP. Current incidence and residual risk of HIV, HBV and HCV at Canadian Blood Services. Vox Sang 2012;103(1):83–6.
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Editorial / Transfusion and Apheresis Science 50 (2014) 3–4
Dr. Katerina Pavenski is a Head of the Division of Transfusion Medicine, hematologist, and a medical director of the Blood Conservation and Therapeutic Apheresis Services at St. Michael’s Hospital, Toronto, Canada. Her undergraduate training was in Genetics at the University of Manitoba (1997). She obtained Doctor of Medicine degree from the University of Toronto (2001) and subsequently completed residency training in Internal Medicine (2004) and Adult Clinical Hematology (2006) in Toronto. She then pursued a two year residency training in Transfusion Medicine at the McMaster University, Hamilton (2006–2008). She joined St. Michael’s in April 2009. She is an assistant professor in the Department of
Pathobiology and Laboratory Medicine at the University of Toronto. Her research interests include hemostasis, therapeutic apheresis and blood management. Katerina Pavenski Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada Address: Blood Transfusion Laboratory, St. Michael’s Hospital, 2 Cardinal Carter Wing, 30 Bond St., Toronto, Ontario M5B 1W8, Canada. Tel.: +1 416 864 5058 E-mail address: [email protected]
Contents lists available at ScienceDirect
Transfusion and Apheresis Science journal homepage: www.elsevier.com/locate/transci
Editorial
PBM symposium introduction
The Society for Advancement of Blood Management (SABM) defines patient blood management (PBM) as 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 [1]. Goodnough and Shander elaborate that blood management is most successful when multidisciplinary proactive programs are in place so that these strategies can be individualized to specific patients [2]. Patient blood management may thus include diagnosis and treatment of perioperative anemia, good surgical technique, topical and systemic hemostatic therapy, and avoidance of unnecessary transfusions among others. The arguments in support of PBM are numerous. Anemia in preoperative patients is common [3] and is predictive of requirement for allogeneic blood transfusion in the perioperative period [4]. Allogeneic blood transfusion may lead to serious complications such as circulatory overload, hemolysis or transfusion related lung injury. Transfusion of allogeneic blood in perioperative setting is also associated with increased duration of hospital stay, infections and mortality [4,5]. When costs associated with production, testing, transfusion as well as management of adverse events, are factored in, the total cost of a single transfused red blood cell unit exceeds 1000 dollars US [6]. PBM respects patient’s autonomy by offering patients a choice, an alternative to transfusion. A growing body of evidence shows that various PBM modalities are safe and effective in reducing the need for allogeneic blood transfusion. Finally, at the core of every PBM program is commitment to patient safety and improvement in quality of care. And yet PBM is not widely embraced, and the reasons for that are also many. Perhaps, one of the explanations is a peculiarity of the Canadian blood system where blood products are provided free to the hospital and yet the hospital is largely responsible for the costs associated with a PBM program. From the transmissible diseases point of view, allogeneic blood is very safe, with risk of HIV
http://dx.doi.org/10.1016/j.transci.2013.12.002 1473-0502/Ó 2014 Elsevier Ltd. All rights reserved.
transmission being estimated at 1 in 7.8 million [7]. Yet another reason may be the lack of awareness of PBM or its benefits. Perhaps, some also may feel that the risks of PBM have not been well documented yet. This symposium will address a few topical questions in PBM including the deleterious effects of anemia, role of erythropoiesis stimulating agents in management of perioperative anemia, and usage of topical hemostatic agents in cardiovascular surgery. The symposium will also feature reports of the two very successful PBM programs, one from the United States and one from Canada. Ultimately, we hope to raise the profile of PBM and engage in discussion all stakeholders – healthcare professionals, hospital administrators, industry, government and of course patients. Disclosures None. References [1] Society for Advancement of Blood Management (SABM) website [accessed 24.12.12]. [2] Goodnough LT, Shander A. Blood management. Arch Pathol Lab Med 2007;131(5):695–701. [3] Beris P, Muñoz M, García-Erce JA, Thomas D, Maniatis A, Van der Linden P. Perioperative anaemia management: consensus statement on the role of intravenous iron. Br J Anaesth 2008;100(5):599–604. [4] Freedman J, Luke K, Escobar M, Vernich L, Chiavetta JA. Experience of a network of transfusion coordinators for blood conservation (Ontario Transfusion Coordinators [ONTraC]). Transfusion 2008;48(2):237–50. [5] Jakobsen CJ, Ryhammer PK, Tang M, Andreasen JJ, Mortensen PE. Transfusion of blood during cardiac surgery is associated with higher long-term mortality in low-risk patients. Eur J Cardiothorac Surg 2012;42(1):114–20. [6] Shander A, Hofmann A, Ozawa S, Theusinger OM, Gombotz H, Spahn DR. Activity-based costs of blood transfusions in surgical patients at four hospitals. Transfusion 2010;50(4):753–65. [7] O’Brien SF, Yi QL, Fan W, Scalia V, Fearon MA, Allain JP. Current incidence and residual risk of HIV, HBV and HCV at Canadian Blood Services. Vox Sang 2012;103(1):83–6.
4
Editorial / Transfusion and Apheresis Science 50 (2014) 3–4
Dr. Katerina Pavenski is a Head of the Division of Transfusion Medicine, hematologist, and a medical director of the Blood Conservation and Therapeutic Apheresis Services at St. Michael’s Hospital, Toronto, Canada. Her undergraduate training was in Genetics at the University of Manitoba (1997). She obtained Doctor of Medicine degree from the University of Toronto (2001) and subsequently completed residency training in Internal Medicine (2004) and Adult Clinical Hematology (2006) in Toronto. She then pursued a two year residency training in Transfusion Medicine at the McMaster University, Hamilton (2006–2008). She joined St. Michael’s in April 2009. She is an assistant professor in the Department of
Pathobiology and Laboratory Medicine at the University of Toronto. Her research interests include hemostasis, therapeutic apheresis and blood management. Katerina Pavenski Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada Address: Blood Transfusion Laboratory, St. Michael’s Hospital, 2 Cardinal Carter Wing, 30 Bond St., Toronto, Ontario M5B 1W8, Canada. Tel.: +1 416 864 5058 E-mail address: [email protected]
