Patient Blood Management: Preserving A Precious Resource

What does the phrase “precious resource” bring to mind? Most Yavapai County residents think “water” but for Yavapai Regional Medical Center (YRMC) caregivers – physicians, nurses and other healthcare professionals – these words are associated with strategies to conserve patients’ blood. YRMC launched its Patient Blood Management (PBM) program in 2012, making this leading-edge approach to care available to patients of western Yavapai County and beyond.

Click here to watch What is Patient Blood Management? on YouTube.

“Only recently has blood conservation and patient blood management become prominent in medical journals,” said Joseph Goldberger, MD, YRMC Chief Medical Officer. “Now Medicare is taking serious interest in PBM so it’s only a matter of time before it becomes the standard of care.”

Click here to watch Rethinking blood transfusion? on YouTube.

Hospitals like YRMC – which operates Arizona’s only PBM program recognized by the Society for the Advancement of Blood Management (SABM) – are looking forward to that day. After years of witnessing how PBM benefits patients who opt to use it, YRMC is even more dedicated to increasing awareness and understanding of PBM.

What’s the goal of PBM? These programs aim to reduce blood transfusion, which are used to replace blood loss due to injury, illness or surgery. PBM programs avoid transfusions by using scientific and safe medical and surgical techniques that prevent anemia, decrease bleeding and improve patient recovery.

“At YRMC, we review all of the triggers that can lead to blood transfusion,” said Dr. Goldberger. “We look for opportunities to reduce transfusions and preserve the availability of blood, which is a precious resource and can be in short supply.”

Along with being a limited resource, stored red blood cells have a short shelf life. Red blood cells stored more than 14 days begin to lose the ability to deliver oxygen-rich cells where they may be most needed in the body.

“A blood transfusion is a liquid transplant so it’s important to understand its risks and benefits,” said Pierre Tibi, MD, FACS, Medical Director, Cardiothoracic Surgery at The James Family Heart Center at YRMC.

The risks associated with blood transfusion include:

Increased infection rates
Kidney, lung and heart complications; and
Higher death rates

It also makes financial sense to conserve blood. The cost of a single unit of blood is $1,500. This price tag includes the cost of testing, packaging, storing and delivering that unit of blood. Additionally, blood transfusions are the most commonly billed hospital procedure at an annual cost of $10-$15 billion nationwide.

When should patients discuss PBM with their doctors? Ideally, PBM begins before hospitalization when a patient and primary care physician work together to prepare for an elective, scheduled surgery. Their collaboration starts with a review of the patient’s blood count and a discussion of what the numbers mean.

“If a patient is taking blood thinners or over-the-counter medications, such as aspirin, the primary care physician will know this important information,” Dr. Goldberger said. “The doctor could also discover that the patient has an undiagnosed bleeding disorder that needs to be addressed to reduce the risk for transfusion.”

More than a month before the scheduled surgery, the physician may recommend diet changes as well as prescribe iron and vitamin supplements. These steps can boost the red blood cell count of people with anemia or help prevent the condition while they are in the hospital.

While hospitalized at YRMC, medical professionals at all stages of care – from the operating suite to the patient bedside – implement PBM strategies to reduce blood transfusions. Those may include:

Following meticulous surgical techniques that reduce bleeding.
Minimizing the frequency as well as the volume of blood draws.
Salvaging blood lost during and after surgery to wash, filter and re-infuse it with red blood cells before returning it to the respective patient; and
Utilizing special machines and medications to reduce the need for blood transfusion

“Blood transfusions can be lifesaving but research shows there also are unnecessary transfusions,” Dr. Goldberger said. “Medicine has learned blood is a precious resource that must be managed with care.”