Autor:in:
Prof. Dr. med. Johannes Peter Aufenanger | Klinikum Ingolstadt | Germany
Since 2010, the implementation of Patient Blood Management (PBM) has been demanded by the World Health Organization.
PBM appears as an evidence-based, patient centred, multidisciplinary approach, aiming to optimise the care of patients who might need transfusion and, consequently, the use of blood products. PBM is based on three pillars: optimise the patient's own blood supplies, minimise blood loss, optimise patient's tolerance of anaemia.
The current state of data shows that unnecessarily administered blood transfusions are associated with an increase in mortality and morbidity.
At the clinical centre of Ingolstadt, we were able to reduce the consumption of packed red blood cells by approximately 50 % in the period from 2010 to 2018, mainly by consistently observing transfusion triggers. At the same time, consumption of coagulation factors (PPSB) and fibrinogen increased due to a change in coagulation management.
In orthopedic und surgical patients in particular, we were able to show the greatest success in patient blood management, not so much through the pre-treatment of iron deficiency anaemia, but through targeted indication for transfusion with the aid of transfusion triggers.
In Germany, preoperative anemia treatment has so far only been established in a few hospitals. In everyday life, the costs of intravenous iron therapy, the separation of outpatient and inpatient care and the potential postponement of the surgical intervention are often used as arguments against the preoperative treatment of anemia. Above all, the question has not been clarified as to who is medically responsible in the German health system for optimal preparation of the patient before surgery, especially in the case of high-risk surgery, and who has to bear the costs of therapy - the practioner, the referring physician, the surgeon, the anaesthesiologist or intensive care specialist or the hospital? In addition to the cost and budget aspects, preoperative anemia treatment could also be beneficial for the patient himself (less transfusion-associated risks and side effects, better healing processes), for the clinic (patient recruitment and marketing) and for the general public (shortage of blood reserves, faster rehabilitation).