Clinical blood transfusion, since its introduction in the early 19th century, remains an important treatment modality in modern medicine. However, blood transfusion is associated with significant risks of complications, which are still here to stay despite the rapid advances in medicine over the last 200 years.
With global population ageing and the resulting supply demand imbalance, efforts have been made to reduce blood treatment. Furthermore, there is growing evidence that transfusion might be associated with unfavorable clinical outcomes.
Therefore Patient Blood Management (PBM), which is an evidence-based, patient-centered, and multidisciplinary approach to optimizing the care of patients who might need transfusion, is emerging in western countries over the last 20 years.
While PBM is gradually becoming the new standard of care and, in principle, it should belong to every clinician, anaesthetist, who possesses a solid foundation in clinical pathophysiology and a perfect armamentarium of technical skills, together with the unique role of taking care of the patients during the entire peri-operative journey, is well-placed to lead the practice of PBM, at least in operative settings.
Enhanced Recovery After Surgery (ERAS) similarly finds Hong Kong its arena for proliferation in recent years, since its earlier footprints in the western countries. Indeed, PBM has been considered one of the ERAS elements. Indeed, PBM is so important in modern medicine that it is more appropriate to phase that ERAS and PBM are supplementing each other. For example, early detection and optimizing of pre-operative anaemia at pre-anaesthetic clinic, as an optimizing patients’ RBC mass strategy in PBM, is also a risk stratification and optimization element in ERAS.
To conclude, shift away from standard transfusion practice to PBM is a paradigm shift. Anaesthetist, being periopeative physician, has an important role to play in the practice and development of it.
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