How Did We Organize a Patient Blood Management Outpatient Anemia Unit at Our Hospital?

Abstract

Dear Editor, Preoperative anemia is a common condition among surgical patients. Its prevalence can reach up to 75%, depending on comorbidity, gender, age, and the underlying pathology necessitating surgery (1). Anemia and transfusion have been associated with increased morbidity and mortality in surgical patients, and the systematic application of a patient blood management (PBM) program in the perioperative period has consistently been found to improve patients’ clinical outcomes following surgery (2,3). PBM is an evidence-based, multimodal, multidisciplinary approach adopted to limit the use of and the need for allogeneic blood transfusions in all at-risk patients, to improve their clinical outcomes (4,5). PBM has three main objectives: improving red cell mass, minimizing blood loss, and optimizing the tolerance of anemia (6). Anemia management is an important principle of PBM. Therefore, to manage preoperative anemia treatment, we organized a specific outpatient anemia unit. Within the scope of planning, we sought answers to three questions: - Which department(s) will manage the anemia outpatient clinic? - Which department(s) will manage the detection of patients with preoperative anemia and their referrals to the outpatient clinic? - Which departments will be required to cooperate in the management of patients with anemia? Patients with anemia who were evaluated preoperatively by the anesthesia and reanimation clinic were referred to the anemia outpatient clinic opened within the family medicine clinic. The first evaluation was conducted in this outpatient clinic. Patients with iron deficiency anemia were treated after evaluation; those who required further examination and treatment were referred to the hematology clinic. A PBM outpatient anemia unit was established on January 17, 2022, at Sakarya University Training and Research Hospital. This is the first PBM outpatient anemia unit in the world. Patients with iron deficiency who are scheduled for elective surgery are referred to this unit during the preoperative period. After oral or intravenous iron treatment, their hemoglobin levels are optimized, and then their surgeries are performed. In this way, the need for blood transfusions during surgery and transfusion-related complications are reduced. At the same time, this unit plays an active role in patient follow-up during the post-surgical period. PBM is teamwork, and we believe that it would be helpful to collaborate with hematology, family medicine, anesthesiology, and surgery specialists to organize the PBM outpatient unit. It may be beneficial to establish PBM outpatient anemia units so that anemia management can be carried out regularly by a single source in hospitals. Keywords: anemia, patient care management, blood, preoperative period, iron deficiencies