Hemoglobin function and patient blood management

Introduction With the stained safety and dubious efficacy of banked blood, in addition to past concerns with limited supply and increasing costs, a fundamental change in the clinicians' approach and attitude toward allogeneic blood transfusions have become necessary. Transfusion should no longer be considered a default decision, but should be a last resort to be used judiciously and sparingly and only when indicated. This shift is further fueled by the inherently complex and uncontrollable nature of allogeneic blood as a de facto “tissue allograft,” which involves a complicated chain of procurement from live donors, processing, storage, and distribution. Any measures that can be used to reduce the use of allogeneic blood components without incurring harm to patients should be explored and adopted. When ordering any treatments, clinicians' primary goal is to provide the best care for their patients. By the same token, the goal in transfusion medicine should not be just limiting blood transfusion, but providing the best care for the patients. This is where Patient Blood Management (PBM) comes to play. PBM is defined as “the timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin (Hb) concentration, optimize hemostasis and minimize blood loss in an effort to improve patient outcome.” In PBM, emphasis is placed on improving the clinical outcomes of the patients as opposed to simple reduction of blood transfusions; nonetheless, the latter is often achieved as a byproduct of implementing PBM strategies. PBM strategies generally fall within one of the following approaches (Figure 9.1; visit www.sabm.org