Patient Blood management (BPM)
Patient blood management is a clinical, multidisciplinary and patient-centred treatment concept focusing on reducing and preventing anaemia and blood loss, and on the rational use of blood products. This concept aims at the safety and the quality of recovery for patients. In the operative setting, the following four treatment emphases are upheld for elective interventions which regularly lead to blood transfusions:
Evaluation and Treatment of preoperative anaemia
Patients planned for elective surgery which regularly leads to blood-transfusions without specific measures are screened, and treated for anaemia according to the following algorithm.
For very large operations, in which a blood-loss of over 1000ml, or a drop in Haemoglobin-concentration of over 30g/L, is expected, low serum concentrations of iron are treated even without signs of anaemia. Treatment consists of preoperative iron-substitution (green branch of the algorithm).
Intraoperative blood-loss can be minimised by:
- Acute normovolaemic haemodilution in selected cases
- Maintaining normothermia
- Meticulous surgical haemostasis
- Avoiding and meticulously treating coagulopathies closely monitored using ROTEM®, Multiplate® and selective laboratory examinations, and treatment according to a coagulation-algorithm using antifibrinolytics, coagulation factors, and selective use of blood-products.
- Targeting lowest possible normovolaemia and normotension
- Restrictive Hb-transfusion thresholds are applied adapted to the patient using the transfusion algorithm (LINK)
- High FiO2 of 0.8 to 1.0 is applied to improve oxygenation and oxygen delivery to tissues
- Situations with high oxygen-consumption are avoided
Selective and sparing use of blood-products:
- Restrictive Hb-transfusion thresholds are applied adapted to the patient using the transfusion algorithm.
- Thrombocyte and plasma-transfusions are exclusively used according to the coagulation-algorithm.