Patient Blood Management

The importance of ROTEM®

ROTEM®-diagnostic: a key player in patient blood management

Blood is the most valuable liquid in the world

  • It transports oxygen, nutritional substances and connects our organs, playing a vital role in keeping us alive.
  • Blood donators give their blood to others and make it possible to save severely injured people and carry out large operations.
  • Meanwhile numerous multi-centric studies have shown that an unnecessary transfusion of allogenic blood products is associated with increased mortality, an increased complication rate (e.g. lung injury and kidney failure) and infection risk (e.g. nosocomial infection and sepsis).
  • Therefore blood should be seen as a drug with a clear indication and a significant range of adverse effects.
  • Due to the current demographic changes it becomes apparent that there is already a substantial shortage of blood products, which is based on a continuous and future decrease in suitable blood donors – while there is a growing need and steadily growing numer of surgical procedures.
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What is Patient Blood Managment?

Video of Department of anaesthesiology, intensive care and pain therapy at the University Hospital Frankfurt

Patient Blood Management (PBM) improves patient outcomes through the application of evidence based medical and surgical strategies that optimise and conserve the patient’s own blood.
As a consequence of better management, patients usually require fewer transfusions of allogenic blood products, avoiding transfusion-associated complications.
A multidisciplinary team determines, with the patient, the specific management plan, which makes every reasonable endeavour to:

  • Optimise the patient’s own blood volume
  • Minimise blood loss
  • Optimise the patient’s physiological tolerance to anaemia

The importance of PBM

The Patient Blood Management concept was highlighted in 2010 by the World Health Assembly, the highest decision making body of WHO, as an important concept to improve patient safety. All WHO member states were requested according to WHA 63.12, to implement this concept in a timely manner.

PBM 3 pillars
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Patient Blood Management was originally implemented for elective surgery. Some of the suggested PBM strategies can generally be considered during pre-, intra- and post-operative care of surgical patients, although it should be emphasised that many of these strategies are not limited to surgical cases and can be used in all patients who are at risk of being transfused.

Strategies applied in PBM generally revolve around the three pillars of PBM:

  • Optimise red blood mass (e.g. treat anaemia before surgery)
  • Minimise blood loss and bleeding (e.g. by monitoring haemostasis and bleeding management with POCT during and after surgery)
  • Harness and optimise physiological reserve of anaemia (e.g. by increasing the tolerance to anaemia)

The key role of ROTEM®-based point-of-care diagnostics within PBM

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See ROTEM® delta and ROTEM® platelet product folder for literature references.

POC diagnostics (ROTEM®) is an integral part of the 2nd pillar of patient blood management.

With ROTEM®-based POC testing, the causes of intra- and postoperative bleeding can be:

  • Detected adequately and timely
  • Treated in a targeted way and prevent massive bleeding and haemorrhagic shock

Transfusion management can be optimised and transfusion related adverse events and complications can be avoided.

Several studies have shown that ROTEM®-based POC testing results in a reduction of transfusion requirements, a shortening of intensive care and hospital stay as well as in an improvement of patient outcome and a reduction of hospital costs.

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