Patient blood management: a primary theme in transfusion medicine

“Have no fear of perfection—you'll never reach it.” —Salvador Dalí “Success is a little like wrestling a gorilla. You don't quit when you're tired. You quit when the gorilla is tired.” —Robert Strauss Patient blood management (PBM) is a clinical, multidisciplinary approach to optimize the care of patients who may need a transfusion. It is the application of evidence-based medical and surgical concepts to achieve measurable improvements in patient safety and clinical outcomes. Secondary gains can include systemwide cost savings, shorter lengths of stay, and decreased readmissions. The goal is clear and the outcomes are significant, sitting squarely within the “Triple Aim.” The literature on PBM is growing and provides clear support for the application of evidence-based guidelines to the practice of transfusion medicine. The changes occurring in the United States health care system have created a readiness for care providers and hospital administrators to consider the full range of PBM interventions. This themed issue contains a collection of articles outlining how patterns of blood use are changing and the widespread impact of PBM on transfusion practice. Implementation of a comprehensive PBM program requires investment in the right mix of resources—including clinical leadership, program evaluation, and technology—to ensure a successful approach. Each institution must tackle the PBM challenge while addressing unique facets of its own culture to achieve sustainability. Like any clinical quality improvement activity, change requires focus and performance measures to reduce variations in clinical practice. Adoption of PBM creates collaborative space for blood centers and hospitals to serve as strong allies in the provision of patient-centered care. Blood centers house tremendous expertise and clinical knowledge and are ready to partner in a supply value framework, bringing medical consultation, programmatic and resource management, and new risk models. This themed issue also contains materials submitted by medical specialists outside the world of transfusion medicine, emphasizing the multidisciplinary nature of PBM. Collaborations among disciplines has become the new reality. The differences in background and knowledge of different specialists working together can only be good for the patient. Clarifying the barriers and the tremendous benefits to be realized from PBM best practices is only the first step. Many institutions have made significant inroads already, others have only just found their clinical champions or secured the commitment from hospital leadership. This themed issue is clear validation that PBM crosses all patient care settings and populations and that—from the ICU to the orthopedic wing, from the operating rooms to the oncology unit—all will benefit from a cohesive PBM program. Although TRANSFUSION has featured a section on PBM since 2011,1 the growing submission of original manuscripts in this area has created the opportunity for the journal and for AABB to cosponsor this themed issue, featuring many exciting clinical studies and operational practice reviews along with editorial comment from leaders in our field. We offer this special edition to our readers as evidence of our growing commitment to PBM and its critical value to the patients served. The authors have disclosed no conflicts of interest.