Patient Blood Management (PBM) has now been emerging to be a patient care and management standard in many developed countries. With ample evidence from observational and prospective studies, patients’ outcomes have been shown to be maintained and even improved with less in-hospital complications with various PBM measures implemented. As by-products, frequencies and quantities of blood transfusion decreased and at the same time, those patients’ outcome improvements were associated with substantial cost saving. Since its introduction of PBM concept in 2011 and one of the strategic frameworks, World Health Organization (WHO) formally issued policy brief to its members countries in late 2021 to call for an urgent need of the PBM implementation. As a follow up, a guidance on the implementation published will be published in 2023.
In Hong Kong, the development of PBM begun in 2014 when the blood transfusion service invited experts to introduce the concept locally. At the same time, a number of PBM related programmes emerged were initiated by individual hospitals. After some months of preparation, Hospital Authority formally established the Patient Blood Management Steering Committee in 2018 with four strategic directions namely on – 1). Good Clinical Management; 2). Transfusion Best Practice; 3). Awareness; and 4) Establishment of Performance Indicators. Activities and works targeted at these 4 directions were then followed up at both central and hospital level.
Over the past few years, despite significant impacts from COVID-19 pandemic, progresses had been well seen at all 4 directions. These included development of corporate guidelines in management of menorrhagia, gastrointestinal bleeding, joint replacement, and iron therapy; local and corporate PBM awareness and educational programmes; locally initiated PBM programmes targeting at their patients’ groups of interest; best transfusion practices through introduction of targeted transfusion therapy, availability of fibrinogen concentrates, single unit transfusion; lastly but not the least development of basic performance indicators to capture the baseline and to facilitate trend monitoring with PBM implementation. Besides, efforts have also been extended outside Hospital Authority to private hospitals and doctors when they not only begun to implement PBM measures but had a far better understanding of anaemia diagnosis and management.
Despite progresses made with encouraging results, there are still many rooms to follow with the ongoing PBM development and sustainability in our local settings. With knowledge and technological advances, evidence based practices would definitely be introduced. At the same time, continued awareness enhancement and education, and evaluation of health benefits gained including economics are the key area to pursuit.
