Society for the Advancement of Patient Blood Management and Anesthesia & Analgesia: A New Collaboration and Home for Blood Management Research.

816 www.anesthesia-analgesia.org October 2016 • Volume 123 • Number 4 Copyright © 2016 International Anesthesia Research Society DOI: 10.1213/ANE.0000000000001583 This issue of Anesthesia & Analgesia (A&A) marks the launch of a new section devoted to “Blood Management. ” It is the result of the collaboration between the Society for the Advancement of Patient Blood Management (SABM) and the International Anesthesia Research Society and its journal A&A’s editorial board. Both bodies are committed to advancing the science of improving patient care. This is the most recent of several cosponsored sections of A&A that bring the reader a diverse spectrum of perspectives and leading edge medical knowledge. The inaugural article that follows this editorial was written by Shander and other SABM leaders, and it highlights the history and views of SABM, the society on “Blood Management. ”1,2 Blood Management is the science of not only providing a safe blood product but also, more importantly, caring for the potential recipient, namely, the patient. Thus, the most specific term is Patient Blood Management (PBM). SABM’s definition of PBM is “The scientific use of safe and effective medical and surgical techniques designed to prevent anemia and decrease bleeding in an effort to improve patient outcome. ” Thus, the concept of PBM embraces the various medical practices aimed at avoiding red blood cell (RBC) transfusions. In addition to anemia prevention, PBM also calls for alternative means to treat anemia such as erythropoiesis-stimulating agents: iron, folate, and vitamin B12, as clinically indicated.3 In the inpatient setting, an important aspect of PBM is the focus on decreasing the risk of hospital-acquired anemia (HAA). 4 HAA is thought to be rampant, underrecognized, and closely associated with the volume of blood collected for diagnostic and routine laboratory tests.5 Several medical societies have taken advantage of the Choosing Wisely campaign to recommend to their members to avoid excessive blood draws to protect the patient from developing HAA.6 Specific recommendations include the Critical Care Societies Collaborative list that states “Don’t order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions,” and the American Society of Anesthesiologists (ASA): “Don’t obtain baseline laboratory studies in patients without significant systemic disease (ASA I or II) undergoing low-risk surgery—specifically complete blood count (CBC), basic or comprehensive metabolic panel, coagulation studies when blood loss (or fluid shifts) is/are expected to be minimal. ” In addition, the Society of Hospital Medicine mentions “Don’t perform repetitive CBC and chemistry testing in the face of clinical and lab stability,” and the American Association of Blood Banks (AABB), “Don’t perform serial blood counts on clinically stable patients” include such recommendations in their top 5 list of “tests or procedures commonly used in their field whose necessity should be questioned and discussed. ”6 For the surgical patient, PBM measures can be taken pre-, intra-, and postoperatively.7 Within each time frame, PBM principles can also be divided into 3 groups such as optimization of erythropoiesis, minimization of blood loss, and the management of anemia. Examples of important practices to accomplish PBM goals preoperatively include detailed risk-benefit assessment and plan for patients taking anticoagulants and antiplatelet agents, and conversations with the surgical team regarding the estimated blood loss and the patient’s cardiac and pulmonary reserves. Intraoperatively, in addition to meticulous surgical techniques, the anesthesiologist team plays a crucial role through the application of one or more allogeneic transfusion-sparing methods. These include the choice of anesthetic, cell salvage/reinfusion, acute normovolemic hemodilution, optimization of cardiac output, ventilation and oxygenation, and application of evidence-based transfusion guidelines. With regard to the latter, the American Society of Anesthesiologists included “Don’t administer packed red blood cells in a young healthy patient without ongoing blood loss and hemoglobin of ≥ 6 g/dL unless symptomatic or hemodynamically unstable” in their Choosing Wisely list.6 In their remarks, they remind the reader that, although the optimal hemoglobin trigger for transfusion varies with the clinical setting, the decision to transfuse should be patient specific. Furthermore, the published evidence strongly suggests that patients exposed to Society for the Advancement of Patient Blood Management and Anesthesia & Analgesia: A New Collaboration and Home for Blood Management Research