Patient blood management (PBM) is a patient-centered, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient’s own blood, while promoting patient safety and empowerment.

PBM starts with diagnosis, followed by the consideration of appropriate patient-specific therapeutic options for management of that patient’s diagnosis, with patient engagement, shared decision-making, informed consent, and clinical follow-up. This overall approach is most likely to improve patient satisfaction and clinical outcome.

Across the globe, an estimated 2.4 billion people (predominantly women) are anemic, and half of them have iron deficiency anemia (IDA). Those suffering from iron deficiency without anemia could be at least double those with IDA. Many of these patients are probably not “in need of a transfusion” but they are definitely in need of PBM.

Mission

The mission of our program is to advance the science of patient blood management through research, education, collaboration, and advocacy.

Goals

• PBM will be a standard of care at UF Health.
• PMB implementation by healthcare professionals will lead to genuine changes in clinical practice and improvements in patient outcomes.
• UF Health will be recognized for advancing the science of PBM through its dedication to research, education, collaboration, and advocacy at national and international forums.

Patient Blood Management

Improved Patient Outcomes

Improved patient outcomes are achieved by managing anemia, optimizing coagulation, using an interdisciplinary and multimodal approach using the latest evidence based PBM practice guidelines, and involving patients in making informed choices about transfusion practice and alternatives to transfusion.

Initiatives

Anemia Pre-Op Anesthesia Clinic

Goals

• To identify and optimize patients with anemia prior to planned surgery
• To develop clear guidelines for the management of anemia prior to elective surgery
• To reduce blood use in adult elective surgery

Education

• “Gator Way” lecture series – Educational initiative for the implementation of PBM best practice in cardiac surgery
  • “Gator Way” guidelines and session info can be found on our bridge. (Only department members can access our bridge site)  
  • Coagulation algorithm implementation
  • Coagulation lab diagnostic testing evaluations
• Maintain and distribute the latest evidence-based references for clinicians to support research or design PBM activities

Quality Projects

• Project Title: Patient Blood Management in Craniosynostosis Surgery at UF Health
• Project Title: Clinical Efficacy and Coagulation Product Utilization: Evaluating the Hemosonics Quantra and TEG Guidance in Cardiovascular Surgery Patients at UF Health
• Project Title: “Review and Evaluation of Implementation of Urgent Transfusion Protocol for Emergent Treatment of Hemorrhagic Shock”
• Interventions to prevent iatrogenic anemia in ICU patients

Leadership

• PBM and Transfusion Safety Committee Leadership
• Provides advice on strategies and initiatives that influence PBM approaches to projects across the healthcare institution informed by experience and expertise
• Developing core policies for implementation and adoption of nationally approved PBM standards
• Leading UF Health in the adoption of PBM best practices that are high-quality; lead to better patient outcomes; are safer for patients, providers, and institutions that deliver care; and emphasize patient-focused decision making

Research

• Maintains FDA IND Protocol for Expanded Access Use of HBOC-201 for Life Threatening Anemia
• Hemoclear ™ Millipore Filtration of Chest Tube Drainage in Cardiac Surgery: A Benchtop Proof of Concept to Cleanse Captured Postoperative Chest Tube Drainage

PBM for Physicians

ICYMI: Major Surgery in a Jehovah’s Witness with Sickle Cell Disease

The American Society of Anesthesiologists (ASA) Committee on Patient Blood Management (CPBM) has compiled a list of strategies that anesthesiologists and other medical professionals can employ to optimize the blood health of each patient, minimize allogeneic blood exposures, and conserve limited blood resources for those who need it most. These include:

• Early Identification and treatment of anemia before elective surgery
• Prevention, Identification, and management of coagulation derangements perioperatively, including use of anti-fibrinolytic agents, factor concentrates, and point-of-care viscoelastic testing
• Employment of blood conservation techniques during and after surgery, including cell salvage, acute normovolemic hemodilution, topical hemostatic agents and the elimination or reduction of non- essential laboratory testing

More Strategies to Minimize Blood Loss & Enhance Blood Production

Appropriate Diagnostic Testing for All Patients

• Minimize blood draw volumes
• Combine tests to reduce phlebotomy frequency
• Restrict routine orders for lab tests

Pre-Operative Strategies

• To raise blood count if your patient is anemic
• Iron therapy – oral and intravenous
• Judicious use of the appropriate ESA
• Vitamin B6, B12, C, folic acid
• Nutritional support
• Consider deep vein thrombosis prophylaxis

Intra-Operative Strategies

• Intra-operative blood salvage
  • collecting patient’s blood outside of the native circulation during surgery, returning these autologous cells after being appropriately processed
• Volume expanders
  • crystalloids, colloids
• Hemostatic agents
  • oral, parenteral, topical
• Acute normovolemic hemodilution
  • removal of a calculated amount of blood during surgery, replaced with IV fluids, and returned after surgery
• Meticulous surgical techniques

Post-Operative Strategies

• Minimize blood draw frequency and volume
• Post-operative blood salvage
  • collecting blood shed after surgery; washing, filtering, and reinfusion of red blood cells
• Judicious use of appropriate ESA
• Nutritional support
• Consider deep vein thrombosis prophylaxis

PBM for Patients

Patient Blood Management is the scientific use of safe and effective medical and surgical techniques designed to prevent anemia and decrease bleeding in an effort to improve patient outcomes.

Patient Benefits

• Improves patient safety by minimizing exposure to blood
• Reduces hospital length of stay
• Minimizes risk of exposure to viruses and other blood-borne diseases
• Decreases the risk of hospital-acquired complications and infections
• Promotes improved outcomes
• Enhances quality of life and well-being

Referral Center

UF Health has gained recognition as a center for Bloodless Surgical Care due to its growing list of clinical champions.

Hemopure

UF Health is one of a small number of institutions in the United States that has access to Hemopure, an artificial blood substitute made from cow blood. Hemopure is a hemoglobin-based oxygen carrier that acts as a bridge while the body regenerates its own blood. The drug provides options for people with life-threatening anemia who have no other alternatives (e.g., patients who have been transfused so many times that their body produces antibodies that attack any new blood) or who decline transfusions for religious reasons. Hemopure is available only under investigational status through the FDA expanded access program to qualifying patients in specific circumstances. Patients must be referred by a physician to UF Health.

Contact

Mary Jane Michael, RN, MS, CCRC

Please contact Mary Jane Michael, Clinical Research Manager, with any patient blood management related inquiries.