Patient Blood Management (PBM): A path to bloodless medicine

Abstract

Introduction: Blood transfusion is traditional and popular, considered beneficial in reducing mortality. Evidence-based medicine (EBM) seeks medical decisions based on scientific evidence. Method: This study evaluated blood transfusion from the perspective of EBM through a narrative review. Results: Review of randomized controlled trials (RCTs) showed that restrictive transfusion reduces mortality compared to less restrictive transfusion. No randomized placebo-controlled trials evaluating the efficacy of blood transfusion were found, creating uncertainty about the effect of blood transfusion, both in the restrictive and liberal modalities, on mortality. Systematic review of the quality of blood transfusion guidelines demonstrated that the guidelines were developed with low methodological rigor. Reviews of observational studies have linked transfusion to increased mortality, with Bradford Hill criteria suggesting a causal relationship. Systematic literature review demonstrates that Patient Blood Management (PBM) promotes reduced mortality and improved clinical outcomes. Although PBM provides an approach to reducing the use of stored blood, it does not challenge the basic assumption that blood transfusion is necessary or beneficial at some point. Conclusion: Following the important bioethic principle guiding the medical profession, "Primum non nocere" (First, do no harm), it is necessary to urgently reevaluate the inclusion of blood transfusion in the medical arsenal, a therapy that presents dubious benefit but proven harms. Until this reevaluation is fully undertaken by the medical community, patients must be fully and adequately informed about all these facts from now on, so that they can fully exercise their autonomy.