Everyone talks about patient blood management but what actually is it? Helen quizzes Dr Suzy Morton on the practical elements of patient blood management, including a run through a practical approach to iron deficiency.
Suzy Morton
Learning Points:
Patient blood management is the multidisciplinary, evidence based approach to care of patients who may need a transfusion. Practically speaking that means diagnosing and treating anaemia (and thrombocytopenia), particularly those at high risk of bleeding e.g. those who require surgery or who are pregnant. PBM can also be thought of as not transfusing those patients who can be treated in other ways in order to preserve the blood supply for those patients for whom there are no alternatives.
Side effects of oral iron relate to iron not being absorbed across the DMT1 transporter in the duodenum, thus causing irriration as it travele through the remainder of the gut. High doses of oral iron upregulate hepcidin, thus inhibiting iron absorption by degradation of ferroportin on the enterocyte basolateral membrane. Oral iron should be given once daily, or every other day. With appropriate counselling, most patients can tolerate oral iron.
Intravenous iron is safer than blood and can be considered in patients who have severe anaemia, are refractory to or (truly) intolerant of oral iron, who require urgent surgery or who are in the last few weeks of pregnancy. It can also be used to overcome functional iron deficiency in the setting of an anaemia of chronic disease. Contraindications include bacterial sepsis and first trimester of pregnancy. Side effects include allergic reactions and infusion reactions. Extravasation can lead to permanent skin staining. (see full SPC for details).
Useful links
NHSBT information on PBM and resources
Studies supporting less frequent oral iron dosing: Stoffel et al., Lancet Haematology 2017; Bulbul et al., Blood 2018
