• The Haute Autorité de santé has issued a set of recommendations on Patient blood management (PBM), aimed at deploying these good practices intended to limit the use of blood transfusions.

  • In a context of very low blood stocks, PBM, or personalized management of blood capital, promotes rational use of blood products.

  • It also improves patient care and post-operative recovery.

Historically low blood reserves, even falling below the safety threshold.

In recent months, for lack of sufficient donations, the French Blood Establishment (EFS) has several times launched the alert, faced with a state of near-permanent shortage of blood products.

In this context, the High Authority for Health (HAS) recommends adapting practices to reduce the use of transfusions as much as possible, by developing Patient Blood Management (PBM), or personalized management of blood capital.

After 18 months of consultation with several learned societies and patient associations, HAS has thus issued a series of medical recommendations aimed at "alleviating the shortage of blood and the risks" linked to transfusions, detailed this Friday during a press briefing at the annual congress of the French Society of Anesthesia and Resuscitation (SFAR).

In short: only transfuse when there is no alternative, and improve patient care to reduce their risk of needing a transfusion during their surgery.

Limit situations where transfusion is unavoidable

“PBM is intended to avoid as much as possible finding yourself in a situation where blood transfusion is inevitable,” recalls Alexandre Pitard, project manager for PBM recommendations at HAS.

It is a set of practices that the WHO has been encouraging since 2010, and which has already been widely deployed in certain countries such as Australia and Germany, with positive results.

This obviously makes it possible "to save blood products in a context of very low stocks, but this is above all intended to improve patient care", insists Professor Xavier Capdevila, head of the emergency department and the anesthesia-resuscitation department at the University Hospital Lapeyronie of Montpellier.

In practice, "the PBM is part of a peri-operative patient journey, which is based on three pillars declined in pre, per and post-operative, details Dr. Marc-Alexandre Theissen, anesthesiologist resuscitator at the Princess Hospital Center Grace of Monaco and Chair of the PBM Working Group.

In the first place, this supposes preoperatively increasing the patient's blood reserves, by detecting and treating the patient's anemia before his operation”.

Why ?

"If he was in a situation of anemia, therefore suffering from a lack of red blood cells in the blood at the time of the surgery, he would most certainly need a transfusion," he explains.

Good practices to deploy obviously in the operating room by “minimizing intraoperative blood loss [during the intervention], continues Dr. Theissen.

First, the anesthesiologist will administer tranexamic acid, a molecule that blocks bleeding, then the surgeon will use minimally invasive techniques, which reduce bleeding, and therefore the risk of transfusion”.

During this phase, “we will also fight against the patient's hypothermia, underlines Professor Capdevila.

This is a very important element: just the fact of installing the patient on the operating table and uncovering him for the intervention lowers his body temperature by 1.2 degrees in less than ten minutes.

However, with each degree lost, the risk of blood loss is increased by 20%.

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Limit transfusion risks for patients by improving their management

Limiting transfusions has, moreover, a medical interest in itself, since this operation presents significant risks.

“A patient to whom a transfusion is avoided is less likely to see his hospitalization prolonged and to have complications, continues Professor Capdevila.

This is not only linked to the avoided transfusion, it is also linked to the anemia itself, which will have been treated upstream.

“Thus, “these best practices represent a fundamental issue for the future of patients, confirms Alexandre Pitard.

When a comprehensive PBM program is implemented, it decreases patient morbidity, length of stay and mortality, he confirms.

According to work carried out in France in 2019, the total number of complications related to surgery decreases by 20% (-27% in cardiac surgery,

And in Australia, where PBM has been widely deployed for several years, "a benchmark study of more than 600,000 patients demonstrates a 28% reduction in mortality, a 21% reduction in the risk of infection, and a length of hospitalization shortened by 15% , adds the HAS project manager.

In addition, this study reports a 41% drop in the number of units of blood products transfused”.

From now on, however, these recommendations must materialize in the real practices of the medical world, a challenge whose complex nature professionals and patients recognize.

“Some countries have taken the lead in deploying these best practices,” admits Professor Capdevila.

France is not behind, we simply have to emphasize the coordinated vision of patient care, and make it understood that this requires additional resources – which is never easy in the hospital.

But by demonstrating that in the end, this translates into real savings with fewer days of hospitalization, fewer complications, preserved blood supplies, and above all better patient recovery, this can only encourage the democratization of these good practices.

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