Patient Blood Management: A Collaborative Approach to Saving Lives
Authors: Dr Rita Govender, Dr Zanre Nell, Dr Tebogo Njinga, Dr Shenaz Asmal, Dr Lelanie Pretorius
Published: May 2025
What is Patient Blood Management (PBM)?
Patient Blood Management (PBM) is a multidisciplinary, patient-centred approach that focuses on preserving and optimising a patient’s own blood throughout their medical care journey. It aims to improve outcomes by reducing transfusion-related complications, hospital stays, ICU admissions, and serious morbidity and mortality.
Defining PBM
First introduced by Professor James Isbister in 2005, PBM was formally defined in 2022 as:
“A patient-centred, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood, while promoting patient safety and empowerment.”
Why PBM Is Needed
- Anaemia is a global public health concern, affecting up to a third of the population.
- Iron deficiency is the most common cause.
- Blood transfusion is now recognised as a tissue transplant with significant risks.
- Three modifiable risk factors negatively impact outcomes:
- Anaemia
- Blood loss
- Blood transfusion
The WHO endorsed PBM in 2010 and reinforced its importance in a 2021 policy brief, stating that nearly every individual can benefit from PBM during their lifetime.
The Three Pillars of PBM
PBM is built on three interconnected pillars, applied across all patient categories—surgical, medical, paediatric, obstetric—whether emergent or elective. These pillars aim to:
- Optimise red cell mass and physiological reserve
- Minimise blood loss
- Reduce or eliminate the need for allogenic transfusions
PBM requires a coordinated, multidisciplinary approach and a personalised treatment plan.
Clinical History in PBM
A detailed history helps:
- Identify the cause of anaemia
- Assess its impact on quality of life and comorbidities
- Detect bleeding tendencies
Pertinent history includes:
- Symptoms: fatigue, headache, palpitations, hair loss, pica, dry mouth, difficulty swallowing
- Blood loss: genitourinary, GI tract, mucocutaneous
- Diet: high intake of tea, coffee, cereals
- Family history: blood disorders, GI malignancies
- Medications: metformin, NSAIDs, antacids, anticoagulants, herbal products
- Surgical history: especially gastric surgery
- Gynaecological/obstetric history: parity, antenatal care, bleeding patterns
Iron Matters
Iron deficiency can exist with or without anaemia. Non-anaemic iron deficiency (NAID) is an early stage of depletion. Symptoms—even without anaemia—should prompt iron studies, ideally on a fasting sample.
Perioperative Management
- WHO recommends preoperative Hb >13 g/dL in adults.
- Even mild anaemia increases surgical risk.
- Iron studies are important even without overt anaemia, especially in patients with comorbidities.
- Screening should occur at least 3–4 weeks before elective surgery.
- Bleeding history guides haemostatic testing.
- Surgery may need to be postponed in anaemic patients on anticoagulants until correctable factors are addressed.
PBM in Pregnancy
- Iron and folate levels should be normal before conception.
- Iron deficiency in early pregnancy increases risks of:
- Maternal morbidity
- Low birth weight
- Prematurity
- Intrauterine growth restriction
Conditions like hypertension, smoking, diabetes, and twinning can compromise foetal iron delivery.
Foetal risks include:
- Impaired brain development (immediate and long-term)
- Postnatal iron deficiency with neurodevelopmental consequences
Role of Transfusion
Blood transfusion is a “liquid organ transplant” and carries risks per unit transfused. It should not be used as a quick fix.
- Transfusion decisions must be based on clinical status, not just Hb levels.
- A single unit followed by reassessment is often appropriate.
- Doctors must discuss risks, benefits, alternatives, and implications of refusal with patients or families.
Conclusion
“Patient blood management is a compelling concept to pre-empt anaemia, correct bleeding disorders, and minimise blood loss. This evidence-based, multidisciplinary approach not only leads to reductions in use of blood and blood products, and therefore to considerable cost savings, but more importantly, it also improves patient outcomes and patient safety.”
— Professor Denton Cooley
Ampath is committed to expanding PBM-certified staff and integrating laboratory services into PBM committees to support holistic patient care.