Implementing patient blood management in a Brazilian public women's hospital: a pre-post implementation study

Patient Blood Management (PBM) is a personalized, evidence-based, and cost-effective approach. In surgery, the objective is to detect and treat anemia, minimal perioperative blood loss, and promote restrictive transfusion practices. It improves clinical outcomes, patient engagement, and reduces costs. We evaluated the effect of PBM on preoperative management of hysterectomies for uterine fibroids and Postpartum Hemorrhage (PPH) in a Brazilian public hospital.

In this pre-post intervention study, a PBM outpatient clinic was established, a Hemorrhage Management Protocol (HMP) was implemented, and low-cost educational initiatives were used. The study period was from 2016 to 2023.

Overall, 36 patients were included; twenty-two returned to a 30-day appointment and had a mean preoperative hemoglobin increase of 2.48 g.dL^-1 (95% Confidence Interval: 1.8-3.16; p < 0.001). Twenty-five underwent surgery. No preoperative prophylactic transfusions were administered. Transfusions of Packed Red Blood Cells (PRBC) had a mean reduction of -77.4 (p = 0.253) before January 2020 and maintained its behavior until 2023 (1.9; p = 0.686). The HMP was activated in five cases for PPH and 23 units of PRBCs and 11 units of Fresh Frozen Plasma (FFP) were transfused (mean of 4.6 PRBC units and 2.2 FFP units per patient). Additionally, 546 healthcare professionals accessed the PBM guidelines via instant messaging during the study period.

The implementation of PBM by leveraging existing resources led to appropriate treatment of iron deficiency anemia before hysterectomies; systematic use of hemocomponents for PPH and sustained reduction on PRBC transfusions.