Patient Blood Management

The term Patient Blood Management (PBM) was first used in 2005 by an Australian hematologist, Professor James Isbister, on the insight that the focus of transfusion in medicine should be shifted from products from the blood bank to patients [1]. PBM, in a nutshell, is a multidisciplinary, multimodal strategy that, by placing patient health and safety at its core, aims to improve clinical outcomes. This approach significantly reduces the use of blood products by addressing all modifiable transfusion risk factors even before transfusion use needs to be considered [2–5]. Therefore, compared to tradition, PBM represents an innovative approach to the management of the “blood resource” that results in the simultaneous adoption of all techniques, interventions, and strategies that are usable in that individual case whose overall outcome is derived from the summation of the results of the interventions themselves. Therefore, PBM works only through the simultaneous application in the same individual of the entire “package’ of interventions. Thus, it is a multiprofessional, multidisciplinary, multimodal, and patient-centered approach to the optimal management of anemia and hemostasis (especially in surgery) that aims to contain allogeneic transfusion requirements by emphasizing the appropriate use of blood components and, where applicable, plasma-derived drugs. It is important to stress the concept that PBM is not focused on a specific pathology or procedure or on a specific discipline or field of medicine, but aims to manage the blood resource in the individual patient who, therefore, acquires a central and priority role. Therefore, PBM goes beyond the concept of appropriate use of blood products and plasma products as it aims to prevent or significantly reduce their use by managing all modifiable risk factors that may involve transfusion in a timely manner. All of this is clearly spelled out in the Society for the Advancement of Blood Management’s definition of PBM, which states that Patient Blood Management should be understood to mean the timely application of evidence-based medical and surgical principles conceived and designed for the maintenance of hemoglobin concentration, optimization of hemostasis, and minimization of blood loss for the purpose of improving patient outcomes [2]. The PBM principles are also used in the implementation of PBM. Implementation of PBM principles requires that: