The President of the Lebanese Society of Anesthesiology highlights the advancements, challenges, and significance of implementing Patient Blood Management (PBM) programmes in Lebanon
By Samia Madi-Jebara
Patient Blood Management is critically important in Lebanon due to numerous structural and logistical challenges within the healthcare system. Unlike many countries with centralized blood banking systems, Lebanon lacks a national blood bank capable of meeting the comprehensive blood supply needs across hospitals.
Instead, each hospital operates its own blood bank, preparing blood for patients on an as-needed basis, especially before surgical procedures. This decentralized approach places significant responsibility on patients to secure blood supplies, often requiring them to arrange for direct donors or to rely on support from non-governmental organizations, such as The Red Cross. However, these resources are unsustainable; for example, the organization Donner Sang Compter recently ceased operations due to funding constraints.
“Each hospital operates its own blood bank, preparing blood for patients on an as-needed basis, especially before surgical procedures. This decentralized approach places significant responsibility on patients to secure blood supplies..”
This situation highlights the essential role of PBM in optimizing blood resources, enhancing patient outcomes, and building a more resilient healthcare system in Lebanon.
Currently, the country operates a decentralized and fragmented transfusion system, relying primarily on replacement or family donors for approximately 70-75% of its blood supply. Voluntary non-remunerated blood donors (VNRDs) contribute an estimated 20-25%, while compensated donations account for around 5-10%.
Challenges in Preoperative Hemoglobin Optimization
One major challenge in Lebanon’s PBM efforts is the limited timeframe for optimizing preoperative hemoglobin (Hb) levels. Patients are typically assessed only a few days before surgery, which constrains opportunities for effective Hb management.
Even when evaluated a few weeks in advance, implementing comprehensive preoperative anemia management strategies remains difficult.
Screening for iron deficiency anemia and administering treatments like erythropoietin or iron supplements are costly interventions. Additionally, these treatments are not currently covered by insurance providers or national social security systems, creating a financial barrier to effective preoperative care.
Awareness and Misconceptions Surrounding Blood Transfusion Practices
There is also a general lack of awareness regarding blood transfusion issues among defense organizations. Furthermore, a prevalent misconception among patients and their families is that the success of a surgical procedure is directly linked to the volume of blood transfused, rather than focusing on the benefits of optimal blood management strategies.
Potential for Reform and Governmental Support
If the Ministry of Public Health mandates routine anemia screening and addresses underlying causes, and if insurance providers, social security, and other third-party payers cover the costs of administering iron and erythropoietin, there could be a reduction in overall healthcare costs by decreasing the reliance on blood transfusions.
Additionally, educating healthcare providers—particularly surgeons—on the benefits of anemia management and blood conservation is crucial to changing current practices.
Endorsement and Progress of the PBM Initiative
Following the World Health Organization‘s call to action on developing and implementing Patient Blood Management Guidelines, the project has garnered strong support from the Lebanese Minister of Health.
Heads of medical societies have been tasked with collaborating on the creation of these guidelines. The PBM initiative has also received endorsement from the Lebanese Order of Physicians (LOP), with a national kickoff announced for July 15, 2023.
The Lebanese Society of Anesthesiology, led by its president, has actively participated in the launch of this program. A roadmap has been established, and the first draft of the PBM guidelines is currently under preparation. Several anesthesiologists in Lebanese hospitals are key stakeholders in this initiative, playing essential roles in the successful implementation and widespread adoption of PBM within their institutions.
For example, at Hôtel-Dieu de France (HDF), a university, tertiary hospital, the PBM program was initiated by anesthesiologists, beginning in 2019 with its application in cardiac surgery, where we successfully reduced blood transfusions by 50%. We also published an article on the effectiveness of administering iron on Day 1 of cardiac surgery.
Additionally, on June 8 of this year, the anesthesia and obstetrics/gynecology departments of HDF organized an open day to screen and treat anemia free of charge, with 200 women screened and followed up.
On October 26, the operating room commission, led by the HDF anesthesia department, organized a half-day event on PBM with guest of honor, Professor Sigismond Lasocki, Chair of the scientific committee of the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA) [see title image].
Additionally, each year, the Lebanese Society of Anesthesia dedicates a session (covering 2 -3 topics) during its two annual conference days.
Prof. Samia Madi-Jebara, President of the Lebanese Society of Anesthesiology
