Patient Blood Management - Statement of the Platform Blood
(http://www.wienerbluttage.at/)
It is a recognized fact that the administration of foreign blood and foreign blood products has disadvantages and risks for the patient. In this sense, great efforts have been made in recent years which have led to a significant reduction in the consumption of foreign blood.
These successes, achieved by selective improvements, such as logistics, training of physicians and improvements in the monitoring of a lower hemoglobin level, are almost exhausted. A drastic improvement in the future requires a team-adapted and individual solution for each patient. Just as one can already speak of the beginning of a personalized cancer therapy, this should also apply to the patient-adapted foreign blood prevention program. Thus, it would be considered as optimal, a patient would be assigned an operation term only if his organism had been prepared for the procedure as best as possible, and not - as is currently customary - the operative term as a controlling factor dominates all other considerations.
This procedure, referred to as Patient Blood Management (patient-oriented blood-care), consists of a number of building blocks, which interrelate or complement one another. At the time of the procedure, the patient should have a good blood count and an unimpaired blood clotting, and to a perioperative organization that aims at the least possible loss of blood.
However, this requires the cooperation of many individual subjects and areas, which range from surgical nurses or institutions, through medical technology, to patients undergoing surgery, as well as surgical and anesthesiological measures, to safe aftercare. Here are a few points:
Established area:
Anemia detection and treatment
Avoiding the medication of anaeminating drugs (e.g., coagulation inhibitors but also medications for the reduction of stomach acid, antibiotics, antidepressants etc.)
Collection of a standardized coagulation profile
Improvement of cardiac resilience
Lung training (for example, in case of maxillary and thoracic operations)
Actual need to evaluate platelet aggregation inhibition or anticoagulation
Medical Technology:
CellSaver
Minasampling (restrictive blood sampling for laboratory tests)
Development of blood-saving techniques in surgery
Surgery:
Use of blood-sparing surgical procedures
Surgical and anesthesiological. Competence Centers
Normothermia
Use of anesthesia techniques that save blood
Hospital:
Selection of appropriate procedures or patients
Point-of-care coagulation diagnostics
Continuous technology evaluation and renewal
Well trained and experienced staff
Sufficient monitoring possibilities to be able to postpone the transfusion as long as possible
Use of alternative medicinal products (such as iron preparations, erythropoietin, vitamin K, etc.) instead of labile + stable blood products
All o.a. Points and a few more have proved their worth for a long time and are implemented individually. A management that every patient receives the necessary and sensible measures is still missing, which leads to unnecessary and expensive foreign blood transfusion on the one hand, and the wrong use of expensive methods on the other hand. Each patient needs an individually defined concept, which should be done when and how, so that a foreign blood delivery can be avoided. The Blut platform would like to call this organizational project into a perioperative concept in the Austrian health system.
From today's point of view, the foreign blood transfusion will continue to play a standard role in our medical life for many years to come because one of the transfusion of equivalent synthetic substitutes will not be available for a long time. However, the use of foreign blood should be used as rarely as possible and replaced as far as possible by safer alternatives. We call on all Austrian health care providers to raise this treatment concept in Austria as a medical standard.
The platform blood
(Dr. Christian Cebulla
Doz. DDr. Robert Fitzgerald
Univ.-Prof. Dr. Paul Höcker
OA Dr. Peter Perger)