​Implementing Patient Blood Management in a Brazilian Public Women’s Hospital: a Pre–Post Implementation Study.

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.背景：患者血液管理（Patient Blood Management, PBM）是一种个性化、循证且具备成本效益的诊疗方案。在外科领域，其核心目标为检测并治疗贫血、最大限度减少围手术期失血，同时推广限制性输血策略。该方案可改善临床结局、提升患者参与度并降低医疗成本。本研究于巴西一所公立医院开展，评估了PBM对子宫肌瘤子宫切除术与产后出血（Postpartum Hemorrhage, PPH）患者术前管理的效果。 方法：本研究为一项前后干预性研究，期间设立了PBM门诊，实施了出血管理方案（Hemorrhage Management Protocol, HMP），并开展了低成本健康教育活动。研究周期为2016年至2023年。 结果：总计纳入36例患者，其中22例完成30天随访，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）。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）输注量的平均降幅为77.4（p=0.253），且该趋势持续至2023年（1.9，p=0.686）。HMP在5例PPH病例中启动，共输注23单位悬浮红细胞与13单位新鲜冰冻血浆（Fresh Frozen Plasma, FFP），每例患者平均输注4.6单位悬浮红细胞与2.16单位新鲜冰冻血浆。本研究未出现死亡病例。此外，研究期间共有546名医护人员通过即时通讯工具访问了PBM指南。 结论：依托现有资源实施PBM，可使子宫切除术患者术前缺铁性贫血得到合理诊疗；针对产后出血系统性使用血液成分输注，并实现悬浮红细胞输注量的持续降低。