Patient Blood Management in Surgical and Critical Care

Patient blood management (PBM) is a multidisciplinary approach designed to optimise the care of patients who might need transfusion during surgical or critical‐care admission. Central to PBM are three pillars: the detection and treatment of pre-operative anaemia, minimisation of blood loss and dilutional anaemia during procedures, and the implementation of restrictive transfusion thresholds tailored to individual patient needs. In the surgical setting, preoperative assessment includes correction of iron deficiency or other treatable causes of anaemia, while intraoperative strategies employ cell salvage, meticulous haemostasis and pharmacological agents such as antifibrinolytics. Postoperative management emphasises appropriate haemoglobin targets to balance oxygen delivery against transfusion risks. In intensive care, chronic and acute anaemia is common due to inflammation, phlebotomy losses and bleeding complications. Strategies here include minimising blood sampling volumes, utilising point-of-care coagulation testing to guide targeted therapy and applying evidence-based transfusion triggers that consider organ perfusion and individual comorbidities. Globally, PBM has been shown to reduce transfusion requirements, lower complication rates, shorten hospital stays and moderate resource utilisation, thereby enhancing patient outcomes and healthcare sustainability.

Research from Nature Portfolio

Recent studies in Scientific Reports have illuminated the complex interplay between anaemia, transfusion and long-term outcomes in cancer surgery. One investigation characterised the prevalence and types of anaemia in colorectal cancer patients, revealing that normocytic anaemia correlated with systemic inflammation and a tendency towards poorer overall survival. This work underscores the importance of early detection and targeted management of anaemia to improve postoperative prognosis. A complementary analysis employed propensity-score matching to examine perioperative blood transfusion in colorectal cancer resections, demonstrating that transfusions were independently associated with reduced disease-free and overall survival, while higher transfusion volumes further increased mortality risk. These findings highlight the need for strategies that minimise transfusions without compromising oncological outcomes.

Patient Blood Management in Surgical and Critical Care publication trend

The graph below shows the total number of articles in patient blood management in surgical and critical care across all publications each year (not limited to Nature Index journals).

Technical terms

Anaemia: A reduction in circulating red blood cells or haemoglobin concentration below normal limits, impairing oxygen delivery.

Transfusion threshold: A haemoglobin or clinical parameter level at which red blood cell transfusion is considered.

Patient Blood Management (PBM): An evidence-based, patient-centred approach to reduce reliance on allogeneic blood transfusions.

Restrictive transfusion strategy: The practice of transfusing at lower haemoglobin levels to minimise unnecessary blood use and associated risks.

Point-of-care testing: Rapid bedside assays used intraoperatively or in the ICU to assess coagulation and guide targeted therapy.

References

1. Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT): a randomised, double-blind, controlled trial. The Lancet (2020).
2. Preoperative anemia in colorectal cancer: relationships with tumor characteristics, systemic inflammation, and survival. Scientific Reports (2018).
3. The Impact of Blood Transfusion on Recurrence and Mortality Following Colorectal Cancer Resection: A Propensity Score Analysis of 4,030 Patients. Scientific Reports (2018).
4. Worldwide audit of blood transfusion practice in critically ill patients. Critical Care (2018).
5. “Simplified International Recommendations for the Implementation of Patient Blood Management” (SIR4PBM). Perioperative Medicine (2017).