Implementing Patient Blood Management in a Brazilian Public Women’s Hospital: a Pre–Post Implementation Study - with lab

Background: Patient Blood Management (PBM) is a personalized, evidence-based, and cost-effective approach. In surgery, the objective is to detect and treat anemia, minimal perioperative blood loss, and promote restrictive transfusion practices. It improves clinical outcomes, patient engagement, and reduces costs. We evaluated the effect of PBM on preoperative management of hysterectomies for uterine fibroids and postpartum hemorrhage (PPH) in a Brazilian public hospital. Methods: In this pre-post intervention study, a PBM outpatient clinic was established, a hemorrhage management protocol (HMP) was implemented, and low-cost educational initiatives were used. The study period was from 2016 to 2023. Results: Overall, ​​36 patients were included; twenty-two returned to a 30-day appointment and had a mean preoperative hemoglobin increase of 2.48 g/dL (95% confidence interval: 1.8–3.16; p < 0.001). Twenty-five underwent surgery. No preoperative prophylactic transfusions were administered. Transfusions of packed red blood cells (PRBC) had a medium reduction of –77,4 (p = 0,253) before January 2020 and maintained its behavior until 2023 (1,9 p = 0,686). The HMP was activated ​​in five cases for PPH and 23 units of PRBCs and 13 units of fresh frozen plasma (FFP) were transfused (mean of 4.6 PRBC units and 2.16 FFP units per patient). No deaths were reported. Additionally, 546 healthcare professionals accessed the PBM guidelines via instant messaging during the study period. Conclusion: The implementation of PBM by leveraging existing resources led to appropriate treatment of iron deficiency anemia before hysterectomies; systematic use of hemocomponents for PPH and sustained reduction on PRBC transfusions. Keywords: anemia, iron deficiency; blood transfusion; hysterectomy; postpartum hemorrhage; preoperative care背景：患者血液管理（Patient Blood Management, PBM）是一种个性化、循证且兼具成本效益的诊疗方案。在外科临床中，其核心目标为筛查并治疗贫血、最大限度减少围手术期失血量，同时推广限制性输血策略。该方案可改善患者临床结局、提升患者参与度并降低医疗成本。本研究于巴西某公立医院开展，旨在评估PBM对子宫肌瘤子宫切除术及产后出血（Postpartum Hemorrhage, PPH）术前管理的应用效果。 方法：本研究为干预前后对照研究，期间设立了PBM专病门诊、实施了出血管理预案（Hemorrhage Management Protocol, HMP），并开展了低成本的健康宣教活动。研究周期为2016年至2023年。 结果：本研究共纳入36例患者，其中22例完成30天随访复诊，其术前血红蛋白平均升高2.48 g/dL（95%置信区间：1.8~3.16；p < 0.001）。共计25例患者接受了手术治疗，未实施术前预防性输血。2020年1月前，悬浮红细胞（Packed Red Blood Cells, PRBC）输注量平均下降77.4单位（p=0.253），该输注趋势持续至2023年（当年输注量为1.9单位，p=0.686）。HMP在5例产后出血病例中启动，期间共输注悬浮红细胞23单位、新鲜冰冻血浆（Fresh Frozen Plasma, FFP）13单位，每例患者平均输注悬浮红细胞4.6单位、新鲜冰冻血浆2.16单位。本研究无死亡病例报告。此外，研究期间共有546名医护人员通过即时通讯工具查阅了PBM指南。 结论：依托现有资源推行PBM实践，可使子宫肌瘤切除术患者术前的缺铁性贫血得到合理诊疗；规范使用血液成分制品治疗产后出血，并实现悬浮红细胞输注量的持续降低。 关键词：贫血；缺铁性贫血；输血；子宫切除术；产后出血；术前护理