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Patient Blood Management (PBM)

Content Type: Protocols | Provider

Created: September 30, 2023
Contributors: Raghavendra Mayya MD • Amanda Rea DNP CRNP AGACNP-BC CCRN CMC CSC E-AEC • Rawn Salenger MD • Rory Tippit MD MPAS • ERAS Cardiac Collaborative Network
Editors: Cheryl Crisafi MSN RN CNLAmanda Rea DNP CRNP AGACNP-BC CCRN CMC CSC E-AEC • Gina McConnell RN BSN CCRN • Shannon Crotwell RN BSN CCRN • Alexander Gregory MD FRCPC •
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Summary

Patient Blood Management (PBM) is a comprehensive, evidence-based approach to improving patient outcomes by preserving and optimizing a patient's own blood. In cardiac surgery, PBM strategies help reduce the risks associated with both anemia and blood transfusion by focusing on three key pillars: preoperative optimization, intraoperative conservation, and postoperative recovery.

Both anemia and transfusions carry risks. Anemia can lead to reduced oxygen delivery to organs, resulting in dysfunction and increased postoperative complications. While transfusions can improve hemoglobin levels, they introduce risks such as fluid overload, kidney injury, infection, and transfusion reactions including TRALI (Transfusion-Related Acute Lung Injury).

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The Virtual Education Center (VEC) and all included content are intended to inform ERAS Cardiac Members on a wide range of topics related to enhanced recovery. The information presented has been provided by enhanced recovery experts and is for educational purposes only.

It is not intended to describe, recommend, or suggest any specific medical practice or intervention, nor should it be considered formal medical advice or consultation. The ERAS Cardiac Society cannot guarantee that the information provided is accurate or complete in every respect. Therefore, the Society is not responsible for any errors, omissions, or clinical outcomes resulting from application of the information obtained through the VEC.

All healthcare professionals should continue to exercise sound clinical judgment and base therapeutic decisions on the best available evidence and patient specific factors.

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References

  1. Brevig J, McDonald J, Zelinka ES, Gallagher T, Jin R, Grunkemeier GL. Blood transfusion reduction in cardiac surgery: multidisciplinary approach at a community hospital. Ann Thorac Surg. 2009 Feb;87(2):532-9. doi: 10.1016/j.athoracsur.2008.10.044. PMID: 19161774.
  2. Gross I, Seifert B, Hofmann A, Spahn DR. Patient blood management in cardiac surgery results in fewer transfusions and better outcome. Transfusion. 2015 May;55(5):1075-81. doi: 10.1111/trf.12946. Epub 2015 Jan 6. PMID: 25565302.
  3. Meybohm P, Herrmann E, Steinbicker AU, Wittmann M, Gruenewald M, Fischer D, Baumgarten G, Renner J, Van Aken HK, Weber CF, Mueller MM, Geisen C, Rey J, Bon D, Hintereder G, Choorapoikayil S, Oldenburg J, Brockmann C, Geissler RG, Seifried E, Zacharowski K, and the PBM-study Collaborators. Patient Blood Management is Associated With a Substantial Reduction of Red Blood Cell Utilization and Safe for Patient’s Outcome A Prospective, Multicenter Cohort Study With a Noninferiority Design. Ann Surg 2016;264:203–211.
  4. Freedman J. The ONTraC Ontario program in blood conservation. Transfusion and Apheresis Science. 2014; 50: 32–36.
  5. Leahy MF, Hofmann A, Towler S, et al. Improved Outcomes and Reduced Costs Associated with a Health-System-Wide Patient Blood Management Program: A Retrospective Observational Study in Four Major Adult Tertiary-Care Hospitals. Transfusion. 2017;57: 1347-1358.
  6. Moskowitz DM, Mcullough JN, Shander A, et al. The Impact of Blood Conservation on Outcomes in Cardiac Surgery: Is it Safe and Effective? Ann Thorac Surg. 2010;90:451-458.
  7. Irving AH, Harris A, Petrie D, Higgins A, Smith J, McQuilten ZK. Impact of patient blood management guidelines on blood transfusions and patient outcomes during cardiac surgery. J Thorac Cardiovasc Surg. 2020 Aug;160(2):437-445.e20.
  8. Althoff FC, Neb H, Herrmann E, Trentino KM, Vernick L, Fullenbach C, Freedman J, Waters JH, Farmer S, Leahy MF, Zacharowski K, Meybohm P, Choorapoikayil S. Multimodal Patient Blood Management Program Based on a Three-Pillar Strategy: A Systematic Review and Meta-analysis. Ann Surg. May 2019;269(5): 794-804
  9. Goodnough LT, Shander A. Patient Blood Management. 2012. Anesthes; 116(6):1367-1376
  10. Tibi P, McClure RS, Huang J, Baker R, Fitzgerald D, Mazer CD, Stone M, Chu D, Stammers AH, Dickinson T, Shore-Lesseson L, Ferraris V, Firestone S, Kissoon K, Moffatt-Bruce S. STS/SCA/AmSECT/SABM Update to the Clinical Practice Guidelines on Patient Blood Management. Ann Thorac Surg. 2021
  11. Task Force on Patient Blood Management for Adult Cardiac Surgery of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Cardiothoracic Anaesthesiology (EACTA), Boer C, Meesters MI, Milojevic M, Benedetto U, Bolliger D, von Heymann C, Jeppsson A, Koster A, Osnabrugge RL, Ranucci M, Ravn HB, Vonk ABA, Wahba A, Pagano D. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth. 2018 Feb;32(1):88-120.

AI Assistance Statement

This summary was developed with assistance from artificial intelligence and reviewed, edited, and approved by the listed editor(s). Reference: OpenAI (2025). ChatGPT (November version) [Large language model]. 
https://chat.openai.com