Successful implementation of a patient blood management programme in a lower middle-income state

Transfusions are common, but their use is decreasing in some countries as a result of increased risk awareness and the implementation of patient blood management (PBM), an evidence-based approach to optimize patient outcomes. This study aimed to detail the implementation of PBM in a Brazilian state and its impact on transfusion rates and associated costs.

The PBM implementation involved several strategies: medical education, haematology consultation services, provision of intravenous iron and other medications, establishment of PBM and perioperative anaemia clinics, cell salvage and acute normovolaemic haemodilution, anaemia reference laboratories and rotational thromboelastometry. The program's implementation was assessed through quality indicators and cost analysis.

Since 2016, there have been reductions in transfusion rates, mainly in red blood cell (RBC) transfusion. Quality indicators showed an increase in single-RBC transfusions from 53% in December 2015 to 85.9% in June 2024 and a decrease in transfusions for patients with Hb ≥7 g/dL from 5.9% in March 2021 to 2.7% in May 2024. The PBM programme led to an estimated annual cost saving of R$2.63 million (US $487,000), if considered RBC direct costs, and from R$9.69 million to R$16.145 million (US $1.79-$2.99 million) in activity-based costs, considering only the reduction in RBC transfusions.

The PBM programme in Ceará successfully reduced transfusion rates and associated costs through a multidisciplinary approach, medical education and government support. This model demonstrates the potential for significant healthcare improvements and cost savings and can serve as a benchmark for other regions and countries, especially in low- and middle-income settings.