The essential role of PBM during the pandemic

Measures to counter COVID-19 severely affected the availability of blood products around the world and forced many healthcare facilities to cancel elective surgical procedures and restrict non-essential care. One innovative strategy used by hospitals to help manage the resulting shortages in blood supply has been the wider use of Patient Blood Management (PBM) programmes.

Large hospitals in New York City adopted multiple strategies to stabilise their blood supply, including encouraging and supporting blood donation, diversifying blood suppliers, enhancing auditing and triaging of provider orders for blood products and increased education about PBM practices – a concept to avoid unnecessary transfusion, including the individualised use of coagulation factor concentrates.

“I became very concerned when local hospitals had blood shortage due to decreased supply. Many blood donors were not comfortable donating early in the pandemic due to safety concerns. Remote work, COVID-19 illness in donors and staff, and the limits that colleges, hospitals and businesses have placed on the number of people allowed in public spaces have all reduced the capacity for large blood drives,” explains Dr Melissa Cushing, the Director of Clinical Laboratories and Director of the Transfusion Medicine Division at a large academic medical centre in New York City and a consultant for Octapharma.  

Replacing conventional blood components with purified coagulation factors, such as fibrinogen concentrate, was a natural step.

Many hospitals are using factor concentrates in cases of trauma, post-partum haemorrhage, cardiac surgery, and liver transplants to provide low-volume potent haemostatic resuscitation. “Hospitals comfortable using fibrinogen concentrate were able to get through the pandemic-induced blood shortages without any cryoprecipitate shortages,” says Dr Cushing.

“Transfusion services in New York City worked on launching a communication campaign to educate our physicians about the blood shortage and asked providers to reconsider the necessity of each blood transfusion order,” she adds. “Looking back now, I greatly appreciate the advantage of having had a strong PBM programme going into the pandemic, with a strong PBM committee that was willing to expand and support the initiative during the pandemic. In the end PBM does improve patient outcomes and has proved to be more important than ever during the pandemic!”