Patient blood management, past, present and future

Abstract: Humans have always been intrigued by blood. During World War II, the rationale of transfusion to save lives has remained the guiding principle of transfusion; however, by the mid-20th century, medical practice changed once blood was readily available. It soon became the norm to order at least a type and crossmatch for major surgery of any kind. This led to a need for patient blood management (PBM), which is a natural continuation of the history of modern transfusion. PBM further expanded and evolved to a multidisciplinary, multimodal, multifaceted approach to optimize patient outcomes by providing an evidence-based transfusion standard of care while incorporating the management of anemia and hemostasis, improving physiologic reserve, and minimizing blood loss. The treatment of Jehovah’s Witness patients (JWP) using methods introduced to avoid blood use, such as maintaining iron stores, optimizing hemostasis, minimizing blood loss, and using cell salvage (CS), laid the foundation of the current practice of PBM. In the 1980’s, the discovery that human immunodeficiency virus (HIV) was transfusion-transmitted caused many of the “basic indications” for transfusions to be reconsidered. As the 20th century ended and the 21st century began, PBM was now beginning to be considered as a “standard of care” and various organizations embarked on the journey to support research into this area. Several professional societies heralded this change towards PBM and created standards and certifications. The move from paper to electronic documents has further expanded the role of PBM, allowing for transfusion-related high-quality data collection, data mining, and big data analytics that can promote informed PBM healthcare decisions. The aim of this manuscript is to walk the reader through the evolution of transfusion medicine that came to fruition in the 20th century through the development of PBM programs in the first quarter of the 21st century and then to provide some insight into what can be expected head during the second quarter of this century.