Recent movement and changes in the field of transfusion medicine have focused much attention on a viewpoint that SABM has actively encouraged and embodied for more than a decade. Simply put, putting the patient’s interests first, rather than the product’s specifications and quality at the center of the transfusion decision. Although such a viewpoint may seem obvious, the concept represents nothing less than a paradigm shift in the way that practitioners apply evidence in engaging in a true risk-benefit calculation when transfusion is considered. An upcoming publication by the renowned transfusion medicine expert and pathologist, Eleftherios Vamvakas, MD, PhD boldly addresses the rapid and dramatic movement as the paths of transfusion medicine and patient blood management veer ever closer.
In the preface of this comprehensive AABB Press book on Decision-Making in Transfusion Medicine, Vamvakas describes a number of fundamental aspects of this paradigm shift, which include moving from allogeneic blood transfusion (ABT) to patient blood management, as well as administering ABT only when empirical evidence indicates that actual (as opposed to postulated) benefit can be expected from the transfusion for a particular patient. Vamvakas focuses at all times on the evidence-based evaluation that must be undertaken when considering the potential benefits of administration of blood products, and also on the importance of the patient and his or her gaining full information about the risks of transfusion and understanding this information to become a partner in the decision-making process.
While numerous individuals and professional organizations have expressed the importance of a patient-centric approach to blood transfusion, as well as the acceptance of the concept of Patient Blood Management as a standard to which all professionals making transfusion-related decisions must adhere, there has been some debate as to who is best suited to further educate, promote, and advance this paradigm shift. Few have more intimate knowledge of the procurement, safety, processing, and demand for blood products for transfusion than do experts in transfusion medicine, pathology, and blood banking. However, their role is inherently removed from the bedside, in that it is the front-line practitioner who must assimilate all available information and make the best decision possible, one in which evidence would indicate that the expected benefits of transfusion outweigh its risks. Thus, we firmly believe that both those whose workplace is the laboratory and those whose workplace is at the side of the patient must work in concert to advance this paradigm shift.
We congratulate Dr. Vamvakas on his scholarly, unbiased, and courageous analysis of the evidence, and we are optimistic that we can all work together with better patient outcome as our goal.
