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Getting patient blood management Pillar 1 right in the Asia-Pacific: a call for action.

Department of Anaesthesiology, Singapore General Hospital, Singapore. Department of Haematology, Singapore General Hospital, Singapore. Department of Anaesthesia, Lyell McEwin Hospital, Discipline of Acute Care Medicine, University of Adelaide, Australia. Institute of Anaesthesiology, University Hospital Zurich, Switzerland. Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Australia. Faculty of Health Sciences, Curtin University Western Australia, Australia. Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, South Korea. Department of Anesthesiology, Critical Care and Emergency, Angers University Hospital, France. Department of Obstetrics and Gynecology, Soonchunhyang University, South Korea. Department of Laboratory Medicine, Haematology Division, National University Hospital, Singapore. Department of Obstetrics and Gynaecology, Hospital Sultan Haji Ahmad Shah, Pahang, Malaysia. Division of Hip and Knee Surgery, National University Hospital, Singapore. Division of Musculoskeletal Oncology, National University Hospital, Singapore. Department of Laboratory Medicine, Inje University Ilsan Paik Hospital, South Korea.

Singapore medical journal. 2020;(6):287-296
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Abstract

Preoperative anaemia is common in the Asia-Pacific. Iron deficiency anaemia (IDA) is a risk factor that can be addressed under patient blood management (PBM) Pillar 1, leading to reduced morbidity and mortality. We examined PBM implementation under four different healthcare systems, identified challenges and proposed several measures: (a) Test for anaemia once patients are scheduled for surgery. (b) Inform patients about risks of preoperative anaemia and benefits of treatment. (c) Treat IDA and replenish iron stores before surgery, using intravenous iron when oral treatment is ineffective, not tolerated or when rapid iron replenishment is needed; transfusion should not be the default management. (d) Harness support from multiple medical disciplines and relevant bodies to promote PBM implementation. (e) Demonstrate better outcomes and cost savings from reduced mortality and morbidity. Although PBM implementation may seem complex and daunting, it is feasible to start small. Implementing PBM Pillar 1, particularly in preoperative patients, is a sensible first step regardless of the healthcare setting.

Methodological quality

Publication Type : Review

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