Patient Blood Management is a book that considers a concept that transcends transfusion medicine. It is solely aimed at disease management rather than focusing on a single therapeutic modality, transfusion.
The foreword by Denton A. Cooley sums up the essence of patient blood management (PBM) by stating that it is a “compelling concept to preempt anemia, correct bleeding disorders, and minimize blood loss.” He continues by stating that this is an evidence-based approach that has yielded the desired outcomes of improved patient’s health and reduced resource utilization. The preface, written by the three editors, expands on the concept and focuses on the intent of this PBM “book” by addressing the multiprofessional and multidisciplinary approach that spans a multitude of topics from preoperative anemia management to management of patients for whom blood is not an option. Although referred to as a book, this publication is more appropriately described as a “manual” on PBM. Recognizing the burgeoning data on patient outcome associated with a large number of possible interventions (beyond the current single approach—transfusion) applied together or as a single modality, this bundled care includes identification, diagnosis and treatment of anemia, blood conservation both surgical and phlebotomy, and “tolerating” anemia, while therapeutic modalities other than transfusions are implemented effectively. The manual’s content would encourage the reader to explore elsewhere for more detailed data and newer data that are constantly being added to the literature.
The editors have gathered a long list of both new and senior contributors to PBM. Although these contributors have been asked to address specific topics, their knowledge of PBM extends far beyond the contributions seen in this manual.
Knowing that this publication is an expansion of the original German version of this book, the extensive list of topics is impressive and covers most if not all related PBM topics and issues.
To the casual reader, the history and development of PBM and additional material on the future of PBM in the new healthcare milieu would be of value. These items are not included in this book. While they are not necessarily needed in this manual, they would help explain the evolution of PBM and are addressed in other PBM textbooks. Offering the long view in medicine can usually explain the present and help form the future.
Each of the chapters is well organized, and for the most part, presents the current thinking in PBM. Although weighted toward transfusion medicine, the editors’ reminder to focus on patients and improved outcome resonates throughout the manual.
Despite overall enthusiasm expressed for PBM, some sections of the text offer recommendations that can be challenged since significant controversy exists on these topics. As an example, the sections on pharmacologic agents, parenteral iron, and erythroid-stimulating agents represent conclusions on the basis of old data that have been challenged and are in need of fresh interpretation. Other recommendations ignore the inconsistency of the data used to make a recommendation such as those present in section “transfusion guidelines.” In regard to transfusion indication, the threshold (“trigger”) in patients with coronary artery disease has not been established. Although addressed in the text, table 5.2 appears to present the information in what seems to be a more conclusive manner. Regardless, most of the recommendations are sound and useful.
Although open to all disciplines of clinical medicine, the surgical approach to PBM dominates throughout the book. One can extrapolate to other patient populations since PBM is written as disease management of entities such as anemia, coagulation defects, and other hematologic conditions rather than concentrating solely on transfusion as a therapy.
Caught between informative and instructive, the manual serves best as an initial overview of each of the topics. It does not lend itself as a guide to therapy nor does it fully expose all of the data and challenges of PBM in an in-depth fashion. The chapters address each topic in a thoughtful and balanced fashion without exposing areas on controversy in any details.
There is no question in this reviewer’s mind that the primary audience is anesthesiologists and surgeons followed by internal medicine and others in related fields. Reading through the stimulating chapters and sections, one quickly finds oneself seeking to attain more information—which can be found, for example, in the section on PBM at www.blood.gov.au—to enhance their knowledge and repertoire on PBM. This manual is an essential step in increasing awareness on PBM and helps organize the topic, resulting in easy reading and, in turn, better patient care and outcome.