Patient blood management and outcome, too early or not?

Patient blood management (PBM) seeks to improve the clinical outcomes of patients through the application of evidence-based medical and surgical concepts designed to maintain haemoglobin concentration, optimise haemostasis and minimise blood loss. Hence, assessment of the outcomes of patients is essential in evaluating the success of PBM programmes. Clinical outcomes measure the meaningful impact of interventions on patients in terms of living longer or healthier or experiencing fewer complications. The assessment of these outcomes can often be complicated and laborious and, therefore, alternative approaches are sometimes explored. Use of surrogate endpoints such as transfusion rates or volume and haemoglobin level, and creating composite outcomes (to achieve higher frequency for relatively rare clinical events such as mortality and major morbidity) are among the common strategies but their use and interpretation have limitations and need careful consideration. Creating registries of patients managed under PBM can be an effective and feasible approach to provide safety and effectiveness data on various clinical outcomes. While outcome data on PBM programmes are limited, the emerging studies support that PBM can be effective in reducing transfusion and, more importantly, improving the outcomes of the patients. Continued and further research in this field is imperative. (C) 2012 Elsevier Ltd. All rights reserved.