Philippine Obstetrical and Gynecological Society, Inc.

Workshop on Patient Blood Management

‘PBM is the new standard of care’

Case studies: developing a PBM bundle to improve patient outcomes

Case 1 40-Year old woman with heavy menstrual bleeding due to uterine
adenomyosis

Pillar 1 Pillar 2 Pillar 3

Optimize Minimize blood loss and Harness/optimize
patient’s own bleeding patient’s tolerance
red cell mass of anemia
and iron stores
Pre- • Screen for anemia • Identify and manage bleeding • Assess/optimize
• Identify underlying risk patient’s physiological
operative disorder(s) causing (past/family history, current reserve and risk factors
anaemia medications, • Compare estimated
• Manage underlying etc) blood loss with
disorder(s) • Minimize iatrogenic blood patient-specific tolerable
• Refer for further loss blood loss
evaluation if • Procedure planning and • Formulate patient-
necessary rehearsal specific management
• Treat iron • Preoperative autologous plan using appropriate
deficiency, anemia of blood donation blood-conservation
chronic (in selected cases or when modalities to minimize
disease, iron- patient blood loss, optimize
restricted choice) red cell mass and manage
erythropoiesis anemia
• Restrictive evidence-
based transfusion
strategies

Intra- • Timing surgery with • Meticulous hemostasis and • Optimize cardiac output
hematological surgical techniques • Optimize ventilation and
operative optimization • Blood-sparing surgical oxygenation
techniques • Restrictive evidence-
• Anesthetic blood-conserving based transfusion
strategies strategies
• Autologous blood options
• Pharmacological/hemostatic
agents
Post- • Treat anemia/iron • Vigilant monitoring and • Optimize tolerance of
deficiency management of anemia
operative • Stimulate post-operative bleeding • Treat anemia
erythropoiesis • Avoid secondary hemorrhage • Maximize oxygen
• Be aware of drug • Rapid warming – maintain delivery
interactions that can normothermia • Minimize oxygen
cause/increase (unless hypothermia specifically consumption
anemia indicated) • Avoid/treat infections
• Autologous blood salvage promptly
• Minimizing iatrogenic blood • Restrictive, evidence-
loss based transfusion
• Hemostasis/anticoagulation strategies
management
• Prophylaxis of upper
gastrointestinal
hemorrhage
• Avoid/treat infections
promptly
• Be aware of adverse effects of
medication