Patient blood management: Team working between clinical transfusiology and clinical pharmacology

Abstract

Introduction: Blood transfusion is the process of donating blood or blood components from a donor to a recipient of blood or blood components. Clinical pharmacology is a medical discipline created in the 20th century, that implies the most effective application of drugs, and it could be considered the culmination of all therapeutic procedures in medicine, or simply in the preservation of human health. Methods: Online search of pharmacology and transfusion literature was conducted using PubMed, Cochrane, Embase, and Scopus databases. Topic: Patient blood management (PBM) is a multidisciplinary multimodal patient-centered approach designed to minimize the use of allogeneic blood components in order to improve the clinical outcome of patient treatment. PBM consists of 3 main pillars with specific clinical goals. 1) First pillar: increasing red cell mass including clinical-pharmacological correction such as erythropoiesis stimulating agents (ESA) - iron and another drugs and optimizing the time for surgical intervention in relation to achieving the required hemoglobin value; 2) Second pillar: minimize blood loss through an adequate selection of surgical and anesthetic techniques, treatment with tranexamic acid (TXA) and autologous blood salvage, and the use of blood substitutes, 3) Third pillar: increasing the patient's tolerance to anemia through maximum improvement of pulmonary and cardiac function, optimizing ventilation, oxygenation and restrictive application of blood components. Clinically it is clear that clinical transfusiology and clinical pharmacology are part of each other originating from the fact that the use of classical medicine as well as the therapeutic use of blood achieves a therapeutic effect in order to improve the clinical status of the patient. Conclusion: Patient blood management implies health teams composed of clinical pharmacologist and clinical transfusiologist with other health care specialists making successful healthcare institutions. The most important thing is to monitor the development of new drugs, new transfusion solutions, and in this area, be especially careful when applying new drugs because of serious side effects that may occur. The agility of PBM is reflected in three pillars that must be harmonized and require continuous team education.