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Patient Blood Management in Critically Ill

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Hematologic Challenges in the Critically Ill

Abstract

Anaemia is much more prevalent than commonly thought and is an independent risk factor for morbidity and mortality. For a long time, transfusion with allogeneic blood components has been considered the only method to correct and reverse anaemia especially in hospitalized and intensive care units (ICU) till the notion that transfusion might represent an additional independent risk factor for morbidity and mortality creating uncertainty among clinicians regarding an appropriate transfusion practice. Patient Blood Management (PBM) evolved from the urgent need for an adequate anaemia management and offers more than 100 measures to optimize patient’s own blood. In general, PBM consist of three pillars: first, a comprehensive anaemia management; second, the minimization of iatrogenic (avoidable) blood loss; and third, the establishment of a rational management of haemotherapy that could include transfusions.

The pathology and physiology of ICU patients are multifactorial due to disease-related and iatrogenic blood loss. Critically ill patients are prone for bleeding due to their primary illness and acquired coagulopathy. Anaemia is extremely common in these patients (60–80%), and after 1 week of ICU stay, approximately 97% of patients are anaemic, and about 39–44% receive at least transfusion of 1 RBC unit. PBM guides the clinician through a timely and evidence-based concept to offer management of anaemia, coagulation and prevention of blood loss at any time during ICU stay and beyond.

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Conflict of Interest

PM and KZ received grants by B. Braun Melsungen, CSL Behring, Fresenius Kabi and Vifor Pharma for the implementation of Frankfurt’s Patient Blood Management Program; honoraria for scientific lectures from B. Braun Melsungen, Vifor Pharma, Ferring, CSL Behring and Pharmacosmos. All other authors have no conflicts.

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This work did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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  1. Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany

    Suma Choorapoikayil, Kai Zacharowski, Christoph Füllenbach & Patrick Meybohm MD

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  1. Suma Choorapoikayil
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  2. Kai Zacharowski
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  4. Patrick Meybohm MD
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Correspondence to Patrick Meybohm MD .

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  1. Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Team Health Research Institute, Englewood, NJ, USA

    Aryeh Shander

  2. Department of Critical Care Medicine, Geisinger Health System, Danville, PA, USA

    Howard L. Corwin

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Choorapoikayil, S., Zacharowski, K., Füllenbach, C., Meybohm, P. (2018). Patient Blood Management in Critically Ill. In: Shander, A., Corwin, H. (eds) Hematologic Challenges in the Critically Ill. Springer, Cham. https://doi.org/10.1007/978-3-319-93572-0_21

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