As part of our ERAS programme, Patient Blood Management (PBM) came into place in Tseung Kwan O Hospital (TKOH) since 2016. PBM is a multidisciplinary, evidence based approach to optimize use of donor blood and to improve clinical outcomes by avoiding unnecessary exposure to blood components.
In TKOH experience, we first started PBM in surgical patients undergoing major colorectal surgery, and then Total Knee Replacement surgery, and later patients undergoing major gynaecological surgeries. Iron sucrose was first used in the beginning of our programme, which had later been replaced by Iron Isomaltoside since its introduction in April 2018, due to its higher single dose limit, thus allowed a shorter time interval to surgery. We identified, evaluated and managed anemia preoperatively. Should iron deficiency anemia be found, we would start either oral or intravenous iron therapy promptly. Intraoperatively, we carefully manipulated patient’s haemodynamics, optimized haemostasis and avoided coagulopathy. While postoperatively, we followed up patients as a team with surgeon, and monitored and managed any postop anemia.
For the period from April 2017 to Mar 2019, a total of 66 surgical patients and 25 gynaecological patients had been given intravenous iron therapy preoperatively. The average rise in Hb level was 2.49 g/dL in the gynaecological group, and 1.55 g/dL in the surgical group. The overall transfusion rate was lowered to 4% in the gynaecological group after the implementation of PBM compared to 8% before, and was 6% in the surgical group compared to 11% before.
We believe PBM had been a great success in TKOH. It significantly reduced transfusion rate and its associated morbidity and costs. With the trend of increasing demand for blood transfusion outweighing the supply of donated blood product, we believe PBM is the future trend to come.
Co-location with:
