Strategic Approaches to Safe and Effective Transfusion Medicine: Integrating Patient-Centered Management

Abstract

Blood transfusion remains a life-saving intervention in modern medicine but carries significant risks, including transfusion-transmitted infections, immunological reactions, and circulatory overload. To enhance safety and efficacy, Good Patient Management Practices (GPMP) have been established in transfusion medicine. GPMP encompasses key principles such as appropriate indication, patient-centered assessment, rational blood component selection, pre- and post-transfusion monitoring, implementation of hemovigilance systems, and continuous clinician education. GPMP is closely aligned with the Patient Blood Management (PBM) model endorsed by the World Health Organization. The three core components of PBM—optimizing the patient's own blood, minimizing blood loss, and improving tolerance to anemia—are reinforced through GPMP practices. Evidence indicates that GPMP and PBM reduce unnecessary transfusions, lower complication rates, improve clinical outcomes, and enhance cost-effectiveness in healthcare systems. This comprehensive review discusses the fundamental principles of GPMP, its integration with PBM, current clinical applications, and its impact on patient safety in transfusion medicine.

Keywords

• blood transfusion
• patient safety
• good patient management practices
• patient blood management
• hemovigilance

Güvenli ve Etkili Transfüzyon Tıbbına Stratejik Yaklaşımlar: Hasta Merkezli Yönetimin Entegre Edilmesi

Abstract

Kan transfüzyonu modern tıpta yaşam kurtarıcı bir uygulama olmakla birlikte, enfeksiyon geçişi, immünolojik reaksiyonlar ve dolaşım yüklenmesi gibi ciddi komplikasyon riskleri taşımaktadır. Bu nedenle, transfüzyon tıbbında güvenliği ve etkinliği artırmak için İyi Hasta Yönetim Uygulamaları (Good Patient Management Practices, GPMP) geliştirilmiştir. GPMP; doğru endikasyonun belirlenmesi, hasta merkezli değerlendirme, uygun kan bileşeni seçimi, transfüzyon öncesi ve sonrası izlem, hemovijilans sistemlerinin işletilmesi ve sürekli klinisyen eğitimi gibi temel prensipleri içerir. GPMP, Dünya Sağlık Örgütü'nün önerdiği Hasta Kanı Yönetimi (Patient Blood Management, PBM) modeliyle yakından ilişkilidir. PBM'nin üç temel bileşeni olan hastanın kendi kanının optimize edilmesi, kan kaybının en aza indirilmesi ve anemiye toleransın artırılması, GPMP uygulamaları ile desteklenmektedir. Literatürde GPMP ve PBM uygulamalarının gereksiz transfüzyonları azalttığı, komplikasyon oranlarını düşürdüğü, klinik sonuçları iyileştirdiği ve sağlık sistemi maliyetlerini azalttığı gösterilmiştir. Bu derlemede, transfüzyon tıbbında GPMP'nin temel ilkeleri, PBM ile entegrasyonu, güncel klinik uygulamalar ve hasta güvenliği üzerine etkileri ele alınmaktadır.

Keywords

• kan transfüzyonu
• hasta güvenliği
• iyi hasta yönetim uygulamaları
• hasta kan yönetimi
• hemovijilans

References

1. 1. WHO. Global Status Report on Blood Safety and Avalablty 2021. Webste. Publshed onlne 2022:1-184. Accessed October 3, 2025. https://www.who.nt/publcatons// tem/9789240051683
2. 2. Carson JL, Guyatt G, Heddle NM, et al. Clncal Practce Gudelnes From the AABB: Red Blood Cell Transfuson  resholds and Storage. JAMA. 2016;316(19):2025-2035. do:10.1001/JAMA.2016.9185
3. 3. Klenman S, Caulfeld T, Chan P, et al. Toward an understandng of transfuson-related acute lung njury: statement of a consensus panel. Transfuson (Pars). 2004;44(12):1774- 1789. do:10.1111/J.0041-1132.2004.04347.X
4. 4. Shander A, Hofmann A, Isbster J, Van Aken H. Patent blood management- e new fronter. Best Pract Res Cln Anaesthesol. 2013;27(1):5-10. do:10.1016/j.bpa.2013.01.001
5. 5. World Health Organzaton.  e urgent need to mplement patent blood management: polcy bref. https://www.who.nt/publcatons//tem/9789240035744. Publshed onlne 2021:1-24.
6. 6. Meybohm P, Froessler B, Goodnough LT, et al. “Smplfed Internatonal Recommendat ons for the Implementaton of Patent Blood Management” (SIR4PBM). Peroperatve Medcne. 2017;6(1):5. do:10.1186/S13741-017-0061-8
7. 7. Carson JL, Carless PA, Hébert PC. Outcomes usng lower vs hgher hemoglobn thresholds for red blood cell transfuson. JAMA. 2013;309(1):83-84. do:10.1001/ JAMA.2012.50429
8. 8. Holst LB, Haase N, Wetterslev J, et al. Lower versus hgher hemoglobn threshold for transfuson n septc shock. N Engl J Med. 2014;371(15):1381-1391. do:10.1056/NEJMOA1406617

9. 9. Carson JL, Stanworth SJ, Guyatt G, et al. Red Blood Cell Transfuson: 2023 AABB Internat onal Gudelnes. JAMA. 2023;330(19):1892-1902. do:10.1001/JAMA.2023.12914
10. 10. Goodnough LT, Pangrah AK. Blood Transfuson  erapy. Medcal Clncs of North Amerca. 2017;101(2):431-447. do:10.1016/j.mcna.2016.09.012
11. 11. Vlaar APJ, Ju ermans NP. Transfuson-related acute lung njury: A clncal revew.  e Lancet. 2013;382(9896):984-994. do:10.1016/S0140-6736(12)62197-7
12. 12. Muñoz M, Acheson AG, Auerbach M, et al. Internatonal consensus statement on the per -operatve management of anaema and ron defcency. Anaesthesa. 2017;72(2):233- 247. do:10.1111/ANAE.13773
13. 13. Henry DA, Carless PA, Moxey AJ, et al. Ant-fbrnolytc use for mnmsng per operatve allogenec blood transfuson. Cochrane Database Syst Rev. 2011;(1). do:10.1002/14651858.CD001886.PUB3
14. 14.  omson A, Farmer S, Hofmann A, Isbster J, Shander A. Patent blood management - a new paradgm for transfuson medcne? ISBT Sc Ser. 2009;4(n2):423-435. do:10.1111/ J.1751-2824.2009.01251.X
15. 15. Olldash F, Kerç M, Zhurda T, et al. E ects of tranexamc acd on death, vascular occlus ve events, and blood transfuson n trauma patents wth sgnfcant haemorrhage (CRASH-2): A randomsed, placebo-controlled tral.  e Lancet. 2010;376(9734):23-32. do:10.1016/S0140-6736(10)60835-5
16. 16. Neunert C, Lm W, Crowther MA, Cohen A, Solberg L.  e Amercan Socety of Hematology 2011 evdence-based practce gudelne for mmune thrombocytopena. Blood. 2011;117(16):4190-4207. do:10.1182/BLOOD-2010-08-302984
17. 17. Estcourt LJ, Stanworth S, Doree C, et al. D erent doses of prophylactc platelet transfus on for preventng bleedng n patents wth haematologcal dsorders a er chemotherapy or stem cell transplantaton. Cochrane Database Syst Rev. 2014;2014(3). do:10.1002/14651858.CD010984
18. 18. Cordova CB, Cap AP, Spnella PC. Fresh whole blood transfuson for a combat casualty n austere combat envronment. J Spec Oper Med. 2014;14(1):9-12. do- :10.55460/6WR8-NER8
19. 19. Dzk WH. Emly Cooley Lecture 2002: transfuson safety n the hosptal. Transfuson (Pars). 2003;43(9):1190-1199. do:10.1046/J.1537-2995.2003.00523.X
20. 20. Bolton-Maggs PHB, Cohen H. Serous Hazards of Transfuson (SHOT) haemovglance and progress s mprovng transfuson safety. Br J Haematol. 2013;163(3):303-314. do:10.1111/BJH.12547
21. 21. Narck C, Trulz DJ, Yazer MH. Transfuson-assocated crculatory overload a er plasma transfuson. Transfuson (Pars). 2012;52(1):160-165. do:10.1111/J.1537- 2995.2011.03247.X
22. 22. Annual SHOT Report 2024 - Serous Hazards of Transfuson. Accessed October 25, 2025. https://www.shotuk.org/shot-reports/annual-shot-report-2024/
23. 23. Barbara A, Carnero-Proett F, Bárbara De Fretas A, Proett C, Hemomnas F. Hemov glance: a system to mprove the whole transfuson chan. Rev Bras Hematol Hemoter. 2013;35(3):158-159. do:10.5581/1516-8484.20130045
24. 24. Stansby D, Russell J, Cohen H, Llleyman J. Reducng adverse events n blood transfus- on. Br J Haematol. 2005;131(1):8-12. do:10.1111/J.1365-2141.2005.05702.X
25. 25. Muntng KE, Klen AA. Optmsaton of pre-operatve anaema n patents before elect ve major surgery - why, who, when and how? Anaesthesa. 2019;74 Suppl 1:49-57. do:10.1111/ANAE.14466
26. 26. Hofmann A, Ozawa S, Farruga A, Farmer SL, Shander A. Economc consderatons on transfuson medcne and patent blood management. Best Pract Res Cln Anaesthesol. 2013;27(1):59-68. do:10.1016/j.bpa.2013.02.001
27. 27. Acton framework to advance unversal access to safe, e ectve and qualty-assured blood products 2020-2023. Publshed onlne 2020.
28. 28. Leahy MF, Roberts H, Mukhtar SA, et al. A pragmatc approach to embeddng patent blood management n a tertary hosptal. Transfuson (Pars). 2014;54(4):1133-1145. do:10.1111/TRF.12362
29. 29. Trentno KM, Farmer SL, Swan SG, et al. Increased hosptal costs assocated wth red blood cell transfuson. Transfuson (Pars). 2015;55(5):1082-1089. do:10.1111/TRF.12958 References