What is the current evidence base for
patient blood management (PBM) in
adults, and what international clinical recommendations can be derived for preoperative
anemia,
red blood cell transfusion thresholds, and PBM implementation
strategies?
Diagnosis and management of preoperative
anemia is crucial, and
iron-deficient
anemia should be treated with
iron supplementation.
Red blood cell transfusion thresholds for
critically ill, clinically stable
patients (
hemoglobin concentration <7 g/dL),
patients undergoing
cardiac surgery (
hemoglobin concentration <7.5 g/dL),
patients with
hip fractures and
cardiovascular disease or
risk factors (
hemoglobin concentration <8 g/dL), and hemodynamically stable
patients with acute gastrointestinal
bleeding (
hemoglobin concentration 7-8 g/dL) are relatively well defined, although the quality of evidence is moderate to low. Further high-quality
research to support PBM is required for a range of clinical scenarios and implementation of PBM programs.