In Practice

Patient blood management: A solution for South Africa

J Thomson, A Hofmann, C A Barrett, A Beeton, G R M Bellairs, L Boretti, M J Coetzee, S Farmer, M W Gibbs, H H Gombotz, C Hilton, C Kassianides, V J Louw, C Lundgren, J N Mahlangu, C B Noel, V Rambiritch, F Schneider, E Verburgh, P-L Wessels, P Wessels, R Wise, A Shander; on behalf of the South African Patient Blood Management Group

Abstract


For more than 70 years the default therapy for anaemia and blood loss was mostly transfusion. Accumulating evidence demonstrates a significant dose-dependent relationship between transfusion and adverse outcomes. This and other transfusion-related challenges led the way to a new paradigm. Patient blood management (PBM) is the application of evidence-based practices to optimise patient outcomes by managing and preserving the patient’s own blood. ‘Real-world’ studies have shown that PBM improves patient outcomes and saves money. The prevalence of anaemia in adult South Africans is 31% in females and 17% in males. Improving the management of anaemia will firstly improve public health, secondly relieve the pressure on the blood supply, and thirdly improve the productivity of the nation’s workforce. While high-income countries are increasingly implementing PBM, many middle- and low-income countries are still trying to upscale their transfusion services. The implementation of PBM will improve South Africa’s health status while saving costs.


Authors' affiliations

J Thomson, South African National Blood Service, Johannesburg, South Africa

A Hofmann, Medical School and Division of Surgery, Faculty of Health and Medical Sciences, University of Western Australia, Australia; Institute of Anaesthesiology, University Hospital and University of Zurich, Switzerland; School of Health Sciences and Graduate Studies, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia; International Foundation for Patient Blood Management, Basel, Switzerland

C A Barrett, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa

A Beeton, Department of Anaesthesiology, Wits Donald Gordon Medical Centre, Johannesburg, South Africa

G R M Bellairs, Western Province Blood Transfusion Service, Cape Town, South Africa

L Boretti, Department of Anaesthesiology, Port Elizabeth Hospital Complex, South Africa

M J Coetzee, Department of Haematology and Cell Biology, National Health Laboratory Service and Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa

S Farmer, Medical School and Division of Surgery, Faculty of Health and Medical Sciences, University of Western Australia, Australia; School of Health Sciences and Graduate Studies, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia

M W Gibbs, Department of Anaesthesiology and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

H H Gombotz, International Foundation for Patient Blood Management, Basel, Switzerland; Department of Anaesthesiology, Intensive Care Medicine and Pain Management, General Hospital Linz, Austria

C Hilton, Western Province Blood Transfusion Service, Cape Town, South Africa

C Kassianides, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Morningside Clinic, Johannesburg, South Africa

V J Louw, Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

C Lundgren, Department of Anaesthesiology, Wits Donald Gordon Medical Centre, Johannesburg, South Africa; Steve Biko Centre for Bioethics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

J N Mahlangu, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg, South Africa; World Federation of Haemophilia International Haemophilia Training Centre, Johannesburg, South Africa; Bleeding Disorders Unit and Clinical Haematology Service, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa

C B Noel, Department of General/Transplant Surgery, Groote Schuur Hospital, Cape Town, South Africa

V Rambiritch, South African National Blood Service, Johannesburg, South Africa

F Schneider, Department of Anaesthesiology and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

E Verburgh, Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

P-L Wessels, South African National Blood Service, Johannesburg, South Africa

P Wessels, Department of Medical Oncology, Faculty of Health Sciences, University of Pretoria, South Africa

R Wise, Pietermaritzburg Metropolitan Department of Anaesthetics, Critical Care and Pain Management, Pietermaritzburg, South Africa; Head Clinical Unit, Critical Care, Edendale Hospital, Pietermaritzburg, South Africa; Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa

A Shander; on behalf of the South African Patient Blood Management Group, Department of Anesthesiology and Surgery, Icahn School of Medicine at Mount Sinai, NY, USA; Team Health Research Institute, Englewood Health, Englewood, NJ, USA

Full Text

PDF (236KB)

Keywords

Patient blood management; Anaemia; Blood loss; Blood utilisation; Blood transfusion; Transfusion practice, Outcome assessment (healthcare); Delivery of healthcare

Cite this article

South African Medical Journal 2019;109(7):471-476. DOI:10.7196/SAMJ.2019.v109i7.13859

Article History

Date submitted: 2019-06-28
Date published: 2019-06-28

Article Views

Abstract views: 322
Full text views: 297

Comments on this article

*Read our policy for posting comments here