Covid-19 has had a negative impact on blood donations; blood conservation has become a priority. (Photo by Naveen Sharma/SOPA Images/LightRocket via Getty Images)
Patient Blood Management (PBM) should be prioritised by healthcare professionals and policymakers to improve patient outcomes, reduce unnecessary transfusions and decrease healthcare costs. Now more than ever, the overuse of blood products in the world, as well as the high demand for blood and lack of adequate supplies has significantly increased the importance of PBM.
A multidisciplinary approach to optimising the care of patients who might need a blood transfusion, PBM focuses on conserving and optimising a patient’s own blood and avoiding unnecessary blood transfusion through early detection and redress of anaemia, as well as blood loss in surgical and nonsurgical patients.
At present, only 1% of the population in South Africa donates blood. This is not enough to maintain an adequate inventory to meet the country’s blood demand, which results in regular supply shortages. Covid-19 has further worsened the shortages as blood drives were impacted by lockdown restrictions and many people including corporates, high school pupils, university and college students were unable to donate blood at their usual centres.
The drive to improve PBM awareness has intensified globally with the World Health Organisation (WHO) last year issuing a policy brief to members on The Urgent Need to Implement PBM as a comprehensive patient care model to significantly and cost-effectively improve health and clinical outcomes for hundreds of millions of medical and surgical patients. This was a follow-up to work which has been happening since the formal endorsement of PBM by the WHO in 2010 and in March 2011, when the WHO organised the Global Forum for Blood Safety: Patient Blood Management to put together an action plan.
According to the WHO, anaemia and iron deficiency are serious global health issues, affecting a quarter of the world’s population. They are associated with vastly increased morbidity and mortality, as well as intensive care unit (ICU) admissions and increased hospital length of stay, which results in additional costs to the healthcare system. In South Africa there is a high prevalence of anaemia and iron deficiency in the elective surgical population and among pregnant women.
In our local public and private hospitals where many surgeries are planned in advance, there is ample time for early detection and intervention for patients presenting with anaemia. PBM should be applied in the care of all patients and more stringently in pregnant women, neonates, children, adolescents and the elderly.
While PBM advocacy is more active now than it has ever been in our country, there still exists a gap in awareness and implementation of PBM as an overall framework to address the risks of iron deficiency, anaemia, blood loss and coagulation.
Of the world’s total blood supply, it is estimated that about 50% is used for surgery, yet the number of blood transfusions could be potentially reduced by considering patient-specific blood conservation methods. Techniques to consider include preoperative optimisation of haemoglobin, management of comorbidities and medications that may increase bleeding or limit it, intraoperative blood preservation approaches, and thorough postoperative management.
Alongside patient blood management and blood conservation as complementary strategies, the South African National Blood Services (SANBS) fully supports PBM as we work continuously within our sphere of influence to promote improved transfusion practises, blood safety and sustainability of the blood supply.
Without ready availability of blood and blood components, it is difficult to implement modern treatment regimens for many malignant diseases, complex surgical operations and emergency procedures.
Locally, the high prevalence of anaemia and other frequently occurring diseases, as well as one of the world’s highest number of persons living with HIV, all contribute to the high rate of blood donor deferrals. Although we have extensive programmes to actively recruit new donors, the number of donors recruited do not always adequately compensate for the number of donors lost due to illness or deferral. It is vital therefore that the blood within our blood banks is used rationally and effectively.
Given the high costs and risks associated with blood transfusions, we advocate its use only when clinically indicated. Decisions to transfuse are not always well informed, and lack of clinician knowledge and education on good clinical transfusion practises and PMB contributes to the inappropriate use of blood.
This is why education, training and awareness are a major focus area for SANBS as we work together with a host of clinical partners and other stakeholders across the healthcare value chain on PBM best practises. The success of this requires buy-in from all stakeholders including government, medical schools, hospital blood committees and the pharmaceutical industry.
This systems synergy approach for PBM across the health system requires that each step in the patient journey from primary care to laboratory and transfusion databases are closely linked to ensure the sustainable use and availability of products across the country including historically underserved areas, such as district hospitals in deeply rural areas. PBM implementation has been achieved in other parts of the world with positive outcomes, which is most encouraging.
In Western Australia as an example, implementation of a unique, jurisdiction-wide PBM programme resulted in improved patient outcomes, reduced blood product utilisation, and product-related cost savings during a study carried out between July 2008 and June 2014.
Overall, 605 046 in-patient admissions were included in the six-year study, with reported reductions in mortality and length of stay associated with their single-hospital-wide intervention, and millions of dollars in cost savings.
The successful national adoption of PBM in South Africa will improve patient outcomes and contribute considerably to cost-effective healthcare.