Page 82 - Hospital Authority Convention 2018

Symposiums Symposiums
HOSPITAL AUTHORITY CONVENTION 2018

S1.1 Why Patient Blood Management is Important in Modern 13:15 Convention Hall C
Healthcare System?

Patient Blood Management – Why is There an Urgent Need for Change?
Hofmann A
Faculty of Health and Medical Science, University of Western Australia, Australia

Impairment that affects the greatest number of people in the world is anaemia, which was accounted for 30% of the world
population in 2015. This condition is associated with weakness, fatigue, difficulty concentrating, low productivity, infection,
heart failure, preterm labour, low birth weight, child and maternal mortality. 56% of the global anaemia burden is found in the
Asia Pacific region. In surgical patients, anaemia is an independent risk factor for major morbidity and mortality. The adjusted
odds ratio (OR) for mortality in severely anaemic compared to matched non-anemic patients is almost threefold and even
with mild anaemia, it is 40% higher. The OR for infections is almost twofold and the OR for red blood cell transfusion (RBC)
fivefold. Surgical blood loss and bleeding is another independent risk factor for major morbidity and mortality. Over the past
seven decades, the default therapy for anaemia and blood loss was the administration of allogeneic blood transfusions.
However, accumulated evidence shows that transfusion is another independent risk factor for mortality, major morbidity and
hospital length of stay. Together, they constitute the detrimental triad of independent risk factors: poorly managed bleeding
acutely induces or exacerbates anaemia, which at a certain threshold may require transfusion.
Enormous clinical, public health and health-economic magnitude of this problem are now increasingly recognised. Patient
Monday, 7 May 2018 anaesthesiological and haemostaseological techniques and interventions; and finally, harnessing and optimising physiological
Blood Management (PBM), an evidence based bundle of care to optimise medical and surgical patient outcomes by clinically
managing and preserving a patient’s blood, is a new clinical standard to solve the pervasive problem. The concept is built
on three pillars: Correcting anaemia by stimulating the erythropoiesis; minimising bleeding and blood loss through surgical,

reserve of anaemia to avoid or reduce the amount of transfused RBCs.

S1.2 Why Patient Blood Management is Important in Modern 13:15 Convention Hall C
Healthcare System?

Patient Blood Management – The Future in Hong Kong
Lee CK
Hong Kong Red Cross Blood Transfusion Service, Hong Kong
As in developed countries, ageing population has cast significant pressure on the healthcare system in Hong Kong. It has
been observed that an exponential growth in demand is seen in both hospital and outpatient services. Blood transfusion
activities and demand are also noted to increase a disproportional magnitude. For the period between 2006 and 2016, there
was a 34.1% increase in blood demand compared with a 7.6% growth in population. The tremendous blood demand growth
has created significant difficulties to maintain an adequate and stable blood supply locally. While the blood transfusion
service is working hard in enhancing collection capacity to cope with ever increasing clinical blood transfusion needs, the
responses to donor recruitment and promotion are in general getting inferior nowadays with difficulties in reaching younger
population in particular. At the same time, donor and blood safety, and low pre-donation haemoglobin are the other key
limitations for blood donation.

On the other hand, strategies in minimising blood utilisation or slowing down the blood demand growth should be a
reasonable approach to develop and implement as soon as possible. Over the last decade, patient blood management (PBM)
has received much attention in many developed countries which has been shown to effectively improve patients’ outcome
and quality of care. At the same time, those countries who have implemented PBM saw a remarkable decrease in blood
demand of up to 20% over the same period of time.

In Hong Kong, public health service utilises about 90% of the blood supply with majority being transfused to medical and
geriatric patients. However, blood utilisation in private setting should not be overlooked. With an expected growth in blood
demand in ageing population, a concerted effort is therefore, necessary to bring in the successful models of PBM into the
territory. It is hoped that every medical and healthcare profession should make him- or her-self well aware of patient blood
management and its associated recent developments in medical and surgical therapies. With these, the professions could
identify their area of issues or concerns where targeted PBM initiatives could then be designed and applied based on their
need and patients’ characteristics.

It is concluded that patient blood management should be well publicised and properly introduced into the local healthcare
system at a reasonably faster pace. With an aim for better patient management, support and active participation from the
health authority and professions are of paramount importance. The end results could also relieve some of the difficulties in
the current blood supply.
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