Blood Management Protocol
International Patient Blood Management (PBM) in Surgery
An evidence-based, multidisciplinary approach to optimize patient outcomes and conserve blood resources
Understanding Patient Blood Management
Patient Blood Management (PBM) is a patient-centered, systematic approach to improve patient outcomes by managing and preserving a patient’s own blood while promoting patient safety and empowerment. In surgical settings, PBM protocols are crucial for reducing transfusion needs, decreasing complications, and improving recovery times.
This flowchart outlines the three-pillar approach to PBM as recommended by international health organizations including the World Health Organization (WHO) and Society for the Advancement of Blood Management (SABM).
- Complete blood count (CBC) and iron studies
- Identify and treat anemia (iron deficiency, B12/folate deficiency)
- Consider erythropoiesis-stimulating agents if appropriate
- Nutritional optimization
- Minimize diagnostic blood loss
- Use pediatric blood collection tubes when possible
- Point-of-care testing to reduce sample volumes
- Continue anemia treatment as needed
- Monitor hemoglobin levels regularly
- Early mobilization to stimulate erythropoiesis
- Discontinue anticoagulants/antiplatelets when safe
- Identify and manage bleeding disorders
- Consider tranexamic acid for high-bleeding-risk procedures
- Meticulous surgical hemostasis
- Minimally invasive approaches when appropriate
- Use of topical hemostatic agents
- Electrosurgery, ultrasonic, or laser devices
- Maintain normothermia
- Appropriate positioning to minimize venous pressure
- Controlled hypotension when appropriate
- Point-of-care coagulation monitoring
- Individualize transfusion triggers based on patient comorbidities
- Optimize cardiovascular function preoperatively
- Supplemental oxygen when needed
- Avoid unnecessary blood draws
- Acute normovolemic hemodilution
- Intraoperative cell salvage
- Microsampling for laboratory tests
- Closed blood sampling systems
- Single-unit transfusion policy
- Use of restrictive transfusion thresholds (Hb 7-8 g/dL)
- Consider patient symptoms over numerical values alone
- Documented clinical justification for transfusions
Key Benefits of Implementing PBM Protocols
Improved Patient Outcomes
Reduced infection rates, shorter hospital stays, and decreased complications associated with transfusions.
Enhanced Safety
Lower risk of transfusion-related reactions, infections, and immunomodulation.
Resource Optimization
More efficient use of blood products, reducing costs and preserving supply for critical needs.
Standardized Care
Evidence-based protocols ensure consistent, high-quality care across surgical specialties.