Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Mar 2013
ReviewEconomic considerations on transfusion medicine and patient blood management.
In times of escalating health-care cost, it is of great importance to carefully assess the cost-effectiveness and appropriateness of the most resource-consuming health interventions. A long-standing and common clinical practice that has been underestimated in cost and overestimated in effectiveness is the transfusion of allogeneic blood products. Studies show that this intervention comes with largely underestimated service cost and unacceptably high utilisation variability for matched patients, thus adding billions of unnecessary dollars to the health-care expenditure each year. ⋯ The patient-specific rather than a product-centred application of these multiple modalities is termed patient blood management (PBM). From a health-economic perspective, the expeditious implementation of PBM programmes is clearly indicated. Both patients and payers could benefit from this concept that has recently been endorsed through the World Health Assembly resolution WHA63.12.
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Best Pract Res Clin Anaesthesiol · Mar 2013
ReviewEmerging haemostatic agents and patient blood management.
The transfusion of allogeneic blood products has been considered as a life-saving procedure for patients suffering from major traumatic injury and those who are undergoing major surgery. The safety of blood products has improved in terms of infectious complications over the last three decades due to advanced donor screening procedures and tests. Nevertheless, non-infectious complications including a blood-type mismatch, volume overload and immunologic and non-immunologic reactions to blood products can adversely affect clinical outcomes. ⋯ Understanding the indications and limitations of conventional haemostatic therapy, and potential indications and complications relating to emerging haemostatic agents, is important for perioperative physicians. In this article, we discuss current issues related to allogeneic plasma products and emerging biological haemostatic agents and techniques. Further, we review the mechanisms of action and available preclinical or clinical data for each therapeutic agent.
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Best Pract Res Clin Anaesthesiol · Mar 2013
Comparative StudyThe chiasm: transfusion practice versus patient blood management.
In recent years it became increasingly clear that allogeneic red blood cell (RBC) transfusions result in increased mortality and major adverse clinical outcomes. The major risk factors for RBC transfusions are preoperative anaemia, high perioperative blood loss and liberal transfusion triggers. ⋯ PBM has been adopted by the World Health Organization as the new standard of care and all member states are urged to implement this concept. Australia is leading the world in that PBM is indeed implemented at the current time.
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Best Pract Res Clin Anaesthesiol · Mar 2013
ReviewPatient blood management and outcome, too early or not?
Patient blood management (PBM) seeks to improve the clinical outcomes of patients through the application of evidence-based medical and surgical concepts designed to maintain haemoglobin concentration, optimise haemostasis and minimise blood loss. Hence, assessment of the outcomes of patients is essential in evaluating the success of PBM programmes. Clinical outcomes measure the meaningful impact of interventions on patients in terms of living longer or healthier or experiencing fewer complications. ⋯ Creating registries of patients managed under PBM can be an effective and feasible approach to provide safety and effectiveness data on various clinical outcomes. While outcome data on PBM programmes are limited, the emerging studies support that PBM can be effective in reducing transfusion and, more importantly, improving the outcomes of the patients. Continued and further research in this field is imperative.