Patient Blood Management

Both anemia and blood transfusions present potential risks to patients having cardiac surgery. Patient Blood Management (PBM) aims to reduce blood transfusions and their associated risks by optimizing the patient’s own blood supply, ensuring efficient use of blood products, and implementing strategies to minimize blood loss. It contributes to improved patient safety, better clinical outcomes, and cost savings in cardiac surgery.

Anemia can negatively affect the recovery process in patients undergoing cardiac surgery through a variety of mechanisms:

Decreased Oxygen Delivery:

• Anemic patients have reduced oxygen-carrying capacity, which can lead to decreased oxygen delivery to tissues and organs, resulting in organ dysfunction and injury.

Increased Morbidity and Mortality:

• Studies have shown that anemic patients undergoing cardiac surgery are at a higher risk of morbidity and mortality. They experience increased rates of infections, longer hospital stays, and higher incidences of postoperative complications.

Although blood transfusions can address anemia by increasing the red blood cell count, they also come with their own risks:

• Transfusion Reactions
• Increased risk of infection
• Increased risk of kidney injury
• Fluid overload
• Transfusion-Related Acute Lung Injury (TRALI)

Principles of Patient Blood Management in Cardiac Surgery:

Preoperative Optimization:

• Identify and treat anemia before surgery to improve red blood cell count and oxygen-carrying capacity.
• Ensure that the patient has adequate levels of essential nutrients like iron, vitamin B12, and folate.
• Stop antiplatelet and anticoagulant medications for the appropriate duration.

Intraoperative Conservation:

• Use of anti-fibrinolytics.
• Use of advanced surgical techniques and technologies to limit blood loss during the operation.
• Collect, filter, and return the patient’s own blood lost during surgery.
• Point-of-care testing to assess and treat coagulopathy.
• Hemodilution to preserve red cell mass.
• Use evidence-based criteria to decide when transfusions are necessary.

Postoperative Recovery:

• Avoid hypothermia.
• Keep track of blood loss and manage bleeding promptly.
• Use evidence-based criteria to decide when transfusions are necessary.

Benefits of Patient Blood Management:

• Reduced need for transfusions
• Improved patient outcomes
• Cost-effectiveness
• Resource conservation

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This summary was written with assistance from artificial intelligence. All text was reviewed, edited, and supplemented by the listed editor(s). Reference: OpenAI. (2023). ChatGPT (Sept 25 version) [Large language model]. https://chat.openai.com/chat

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