Patient blood management—it is about transfusing blood appropriately

: Until the last decade it was very difficult to extract a large amount of transfusion data from medical records, as most were on paper. This made the process arduous and feasible for only auditing a random sample of transfusions for compliance with guidelines. With the initiation of electronic medical records (EMRs) at most institutions, large amounts of transfusion data are available, yet extraction remains a challenge. Once patient blood management (PBM) informatics are in place, it is important to use the data to educate clinicians about transfusion guidelines and clinical evidence from randomized controlled trials (RCTs) supporting restrictive transfusion. A robust program for PBM education program can create buy-in for adherence to the guidelines. Effective blood utilization review programs may be associated with lower transfusion risks, reduced costs, and improved quality outcomes. The first step in implementing a blood utilization review program is to establish a set of institution-specific, evidence-based transfusion practice guidelines for each blood component, including component modifications such as irradiation where appropriate. Once local transfusion practice guidelines have been established and communicated to the medical staff, the blood utilization review program should establish audit criteria for monitoring of transfusion ordering practices. Audit data should be analyzed and reported regularly. Current technology allows for modification of blood components including leukocyte-reduction, cytomegalovirus (CMV)-reduced risk cellular components, irradiated blood components, washed blood components, volume reduction, and frozen-thawed-and deglycerolized products. All blood products must be part of PBM to ensure they are ordered for the appropriate indications. In those patients’ refractory to platelet transfusions, human leukocyte antigen (HLA) matched or crossmatched platelets can be provided. Adherence to transfusion guidelines should be an institutional priority at every medical center. Widespread compliance with guidelines will result in increased quality as well as cost savings for patients, payers, and medical centers, as well as preservation of the blood supply for patients who truly need transfusions.