Patient Blood Management is not about blood transfusion: it is about patients’ outcomes
In an editorial published in Blood Transfusion, Thomas Frietsch, Aryeh Shander, David Faraoni and Jean-Francois Hardy comment on the results of the Frankfurt Consensus Conference on Patient Blood Management (Müller MM et al. JAMA 2019;321:983-97). The conference produced ten clinical recommendations and twelve research statements relating to preoperative anaemia, red blood cell transfusion thresholds and implementation of PBM programmes.
“We can only agree with some of the recommendations put forward by the 2018 Frankfurt Consensus Conference, the authors write, but we feel that a true consensus between blood bankers, clinicians well-versed in the management of patients undergoing major surgery at risk of bleeding and researchers in the field would have sent a stronger and more relevant message in favour of PBM. Unfortunately, in our opinion, this was not the case here, at least not entirely.”
The report of the Frankfurt Consensus Conference on PBM rated the level of evidence regarding implementation of PBM programmes to improve appropriate RBC utilisation as “Conditional recommendation, low certainty in the evidence of effects”. When evaluating the evidence supporting the value of PBM as a clinical concept, it shoould however be remembered that PBM is a clinical “bundle” promoting the implementation of a patient-centred and multimodal strategy, and therefore it does not lend itself to being studied in the same manner as a single therapy (such as transfusion) does.
Importantly, the authors note, PBM has moved from a product-centred approach to a patient-centred approach. “PBM is centred on patients, more specifically on those who undergo major surgical or major medical procedures that put them at an increased risk of complications or mortality. PBM is not an offensive against producers of blood components. PBM aims to improve the outcomes of patients at risk through the optimisation of the patient’s condition before, during and after the procedure.”