Patient blood management: it is time to streamline targeted therapy options.

摘要: By searching in the U.S. National Library of Medicine March 2015, surprisingly less than 100 articles titles contain term ‘patient blood management’. Nevertheless, patient management has been received much attention worldwide recent years, resulting hospital-based or national campaigns to educate physicians and nurses three-pillar concept [1]. Like many other medical procedures, aims at improving patients' outcome safety. then, everything seems be business as usual, obviously one might not imagine that topic is highly charged both politically emotionally. All stakeholders healthcare need overcome ongoing controversy about benefit-risk ratio transfusions. Patient defined evidence-based multidisciplinary approach preoperatively screen treat patients for anemia, minimize intraoperative loss by elaborating meticulous surgical techniques, individualized goal-directed coagulation cell salvage, finally harness patient's physiological capacity compensation low hemoglobin levels prior application allogeneic transfusions [1,2]. Compared with initiatives optimal use their motto ‘transfusion right unit time’, it obvious a broader covering more issues. The medicine approaches are well accepted vast majority scientists facilitates individual decision making diagnosis, investigation, and/or therapy emphasizing different evidence from well-designed well-conducted randomized clinical trials, systematic reviews, meta-analyses. Patient strictly based on principles medicine. Therefore, promotes turning away purely empirical knowledge fosters conduction further trials special subsets, e.g. septic shock [3] traumatic brain injury [4], The results these two studies line overall statement recently published Cochrane review evaluated data 19 total 6,264 involved [5]. The describes teamwork multiple disciplines ‘redefine problems outside normal boundaries reach solutions new understanding complex situations’ (http://en.wikipedia.org/wiki/Multidisciplinary_approach). This definition free encyclopedia Wikipedia perfectly fits challenges management. To increase effectiveness specialists possible participating programs. includes anesthesiologists, surgeons specialties, intensive care transfusion hemostaseology. Furthermore, programs expanded into nonsurgical such those internal medicine, oncology, pediatrics. Obviously, successfully implementing bedside primary target persons order avoid unnecessary inappropriate application. They should particularly educated updated policies alternative interventions preoperative treatment anemia intravenous iron erythropoietin. Anemia an independent risk factor higher morbidity mortality [6,7]. does focus simply adherence triggers specific cohorts, threshold 7 8 g/dl [8], but screening, monitoring, any kind mild severe intervention during treatments if indicated [2]. Considering obtained variety time streamline targeted options either correct deficiency who undergo surgery identify complications myocardial cerebral ischemia due thus will benefit transfusions. Blood donation establishments field aware paradigm shift restrictive its strict avoidance, suitable alternatives available, already underway health research nowadays [2]. We do strengthen our professional ethics cure ameliorate illnesses injuries best knowledge. So, voluntary donations state-of-the-art rather issue quality quantity.