Patient Blood Management
What is patient blood management?
Patient Blood Management (PBM) is the scientific use of safe and effective medical and surgical technologies designed to prevent anemia and decrease bleeding in an effort to improve patient outcomes. The PBM program at Wake Forest Baptist Medical Center uses a team approach to assess a patient’s blood management needs. The goal of the team is to develop a plan of care that uses pharmaceuticals, technology and techniques to decrease blood loss and to enhance red blood cell production. This approach reduces or eliminates the need for a blood transfusion.
Why is patient blood management necessary?
- Conserves the use of a precious community resource
- Reduces unnecessary hospital and patient care costs
- Improves patient safety by minimizing exposure to blood
- May reduce hospital length of stay
- Reduces the potential exposure to viruses and other blood-borne disease
- May reduce the risk of hospital acquired complications and infections
When would my doctor recommend a blood transfusion?
A blood transfusion may be ordered when the body cannot produce blood quickly enough due to:
- Significant blood loss caused by trauma or high blood loss surgery
- Blood cell destruction caused by immune system reactions, complications to previous blood transfusions or diseases such as sickle cell
- Decreased blood cell production because of medications, chemotherapy or serious illness
What are the risks of receiving blood products?
- Adverse reactions are reactions that may occur during or after a blood product transfusion. Some adverse reactions are not serious, such as a rash, itching or a fever. Other adverse reactions are rare but can be very serious, even life-threatening. Talk to your doctor about your risk of an adverse reaction from a blood product transfusion.
- While all donated blood is screened and tested for potential viruses, bacteria and parasites, occasionally these agents can still infect a transfused patient after the procedure. Talk to your doctor about your risk of a blood-borne infection from a blood product transfusion.
- Modulation of your immune system which may lead to wound infection and in certain operations, kidney injury. Talk with your doctor about your specific risks.
What are my treatment options if I accept blood products?
Allogeneic Blood — donated by an anonymous person
- Red blood cells (RBC) transport oxygen from the lungs to body cells and help transport carbon dioxide from the body cells to the lung
- Platelets prevent blood loss by stopping bleeding at the site of an injury
- Plasma contains clotting factors that contribute to blood clotting
- Cryoprecipitate contains a concentration of clotting factors taken from the plasma
Directed Blood — donated by a friend or relative for you
- Direct blood is not immediately available
- Direct blood donations have not been shown to be safer than the community blood supply
Autologous Blood — use of your own blood
- Hemodilution – removal of a specific amount of your blood during surgery, replaced with intravenous fluids and returned after surgery
- Intraoperative blood cell recovery (cell salvage) – collection of blood lost during surgery, appropriately processed on a continuous circuit
- Predonation – donating your own blood prior to surgery. Predonation can contribute to pre-operative anemia.
What are my treatment options if I decline blood products?
At Wake Forest Baptist Medical Center we honor the wishes of patients who decline blood products for any reason and will continue to provide the best care possible. Our bloodless medicine program provides medical and surgical treatment without the use of allogeneic blood or primary blood components.
- Medications to treat anemia such as iron, folic acid, vitamin B12, erythropoietin (EPO) and darbepoietin (Aranesp)
- Medications to stop bleeding such as tranexamic acid, tissue sealants or adhesives derived from human or animal clotting factors; DDAVP; treated blood products or non-blood products that reduce the risk of infection such as clotting factors and fibrinoge
- Cell salvage is the collection of blood shed during surgery, appropriately processed on a continuous circuit and reinfused
- Acute normovolemic hemodilution is the removal of a specific amount of your blood during surgery, replaced with intravenous fluids and returned after surgery