Value, Impact of Patient Blood Management
Patient Blood Management (PBM), a multimodal and multidisciplinary approach to limit the use and the need for blood transfusions in at-risk patients, arrives in Mexico to improve clinical outcomes. PBM encompasses all aspects of the transfusion decision-making process, beginning with the initial patient evaluation and continuing through clinical management, explained Christa Seipelt, International Product Manager Diagnostics, Sarstedt AG&Co.KG.
PBM “is fundamental because, for example, for the most vulnerable patients such as children, the elderly or the chronically ill, taking frequent and numerous blood samples weakens them and might force them to receive foreign blood, which is a benefit but does not strengthen vulnerable patients when their blood was already weak,” said Seipelt.
Laboratories need to consider many aspects before drawing blood, including the patients’ conditions and medical records and blood extraction guidelines, said Rafael Guerrero García, Vice President of the Board of Directors, Mexican Council of Clinical Pathology. Laboratories must also take into account that they must extract the smallest possible quantities to avoid affecting the patient and potentially causing or aggravating anemia, which could further complicate the patient's condition.
“Blood extraction implies a responsible request for studies and the use of methodologies that would sustain the patient as long as possible,” said Guerrero. In a regular blood extraction patients may lose up to 25 percent of their hemoglobin, which is not always necessary, said Seipelt.
This loss of hemoglobin is more alarming in pediatric patients because their total blood volume is much less than an adult’s, said Israel Parra Ortega, Head of the Clinical Laboratory Department, Children's Hospital of Mexico Federico Gómez. “In fact, there are studies that require that the patient has not received a transfusion,” he said.
For pediatric patients, less blood volume handled means less risk of an infection, making PBM even more important. “PBM means patient safety and the efficiency of analytical and laboratory processes. Such benefits must be shared to make this practice a standard process in the health system,” Parra said.
Despite its importance, PBM has not been widely applied in Mexico neither in adults or infants, impacting health outcomes and increasing costs. “Only 2-3 percent of laboratories in Mexico take optical blood management measures,” said Guerrero.
“Although there are already clear guidelines to be able to establish PBM, we have not been able to adopt them,” said Parra. Experts recommend that the effective way to standardize PBM is through regulation. Some of the best PBM practices are used in Germany and other EU countries that have proved that PBM can be standardized in a healthcare system.
“While it has not been greatly adopted in Mexico, professionals are showing interest in PBM,” said Seipelt. Those professionals, alongside the public health sector, generated the clinical practice guidelines for patient blood management of public institutions, which is proof of the interest and is a first step to expand its impact, she added.
Transitioning to PBM implies avoiding extracting unnecessary blood samples and having reserve samples. “Diagnostic studies need to be requested more thoughtfully and take into account the patient's record by establishing protocols and awareness,” said Arturo Vivas, Product Diagnostic Specialist, Sarstedt.
Common practices include taking 800 ml of blood for a serum clinical chemistry, but “the truth is that that amount is not really necessary,” said Seipelt.
Proper use of blood extraction and management tools is also important, said Parra, because some procedures require the extraction of more blood than others. Even when the volume extracted is small, it is still a loss for the patient. However, laboratories need to ensure to have a large enough sample to avoid compromising the study, said Parra. “I would like to see more work and scientific information made by and for Mexicans, because that is important to standardize the practice and recognize limitations and opportunities of the system,” he said.
Awareness forums for laboratories and professionals regarding PBM are necessary for these concepts to permeate to all professionals. But most importantly, PBM “should be included in the Mexican Official Norm and mandated in the functions of the health professional,” said Guerrero.