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World Patient Safety Day – Why improving the diagnosis of anaemia is a win-win

WFSA President Daniela Filipescu on why improving anaemia diagnosis can improve patient safety and reduce costs.

This World Patient Safety Day WFSA is highlighting the impact that effectively diagnosing anaemia can have on patient safety.   

World Patient Safety Day is a huge opportunity to raise public awareness and promote collaboration between different stakeholders to improve patient safety.

Patient Safety is central to anaesthesiology and is firmly embedded into WFSA’s mission and strategic priorities.

This year’s theme of WPSD, “Improving diagnosis for patient safety” highlights the critical importance of correct and timely diagnosis in ensuring patient safety and improving health outcomes.

For surgical patients one area of improved diagnosis that will have a significant impact is anaemia. Globally, the numbers are staggering:

  • Over 1.6 billion people affected worldwide with anaemia, including a high prevalence among pregnant women, children, and individuals in low- and middle-income countries 1
  • Preoperative anaemia is found in up to 75% of surgical patients 2
  • Up to 30–40% of surgical patients are underdiagnosed for anaemia. 3

Misdiagnosis or under-diagnosis of conditions like anaemia significantly impacts surgical patients worldwide by increasing the risk of perioperative complications and mortality, and prolonging recovery times 4, due to inadequate preparation and management. This often results in higher rates of blood transfusions, extended hospital stays, and greater healthcare costs, ultimately affecting overall patient safety and outcomes. Moreover, the combination of anaemia and transfusion dramatically increases the risk for adverse postoperative outcomes 5.

Anaesthesiologists, as perioperative physicians, should take every reasonable measure to diagnose and respond to pre-intra and post-operative changes to their patient’s physiology and condition.

Anaemic patients are more vulnerable to perioperative hypoxia, cardiac complications, and prolonged recovery 6. Anaemia also increases the likelihood of poor functional outcomes and wound healing. For anaesthesiologists, managing anaemic patients requires meticulous planning, including strategies for patient blood management (PBM) to reduce transfusion needs and improve surgical outcomes.

Anaemia is both preventable and treatable 7,11 . It is the anesthesiologist’s role to optimize patients’ own blood volume, to minimise the patient’s blood loss and enhance the patient-specific physiological tolerance of anaemia, which constitutes the three pillars of the modern concept of Patient Blood Management (PBM).

Recently, the WHO called for all member states to “act quickly through their ministry or department of health to adopt their national PBM policy, install the necessary governance, and reallocate resources to improve the population health status and individual patients outcomes while reducing overall health care expenditures” 12.

We, at the WFSA, endorse this WHO call to action. Over the past year we led innovative work in the field of PBM, including an outreach campaign to WFSA Member Societies to secure their support for a global PBM declaration and commitment to PBM implementation.

Educational gaps in the field of PBM are among the main barriers to the implementation of PBM programmes13. To promote education on PBM for health professionals we launch today a webinar series on PBM principles and programmes.

2024 WPSD theme’s of improving diagnostic safety provides an opportunity to focus on the importance of detecting anaemia perioperatively in order to correct it for a better and safer outcome for our patients.

Approximately 100 million surgeries are performed on anaemic patients every year 14. This puts tremendous pressure on transfusion services worldwide, especially in low-resource settings, where blood donations are insufficient to increase access to safe emergency surgery 15.

Correct and timely diagnosis and treatment of anaemia perioperatively is key for patient safety all over the world 16.

Empowering patients to participate in decision-making and informed consent related to PBM measures is central to PBM implementation 17 and supported by the recent consultation initiated by the WHO Patient Safety Flagship.

With the WPSD ‘s slogan “Get it right, make it safe!” I urge you to take the lead and diagnose anaemia perioperatively in all patients to prevent the consequences of neglecting or delaying the interventions to correct it.

I wish you a Happy WPSD!

WFSA P-PBM Steering Group Members and Collaborators on the importance of P-PBM this WPSD

References

  1. Kassebaum NJ, Collaborators GBDA. The Global Burden of Anemia. Hematol Oncol Clin North Am. 2016;30:247-308
  2. Beyable AA, ,Berhe YW, Nigatu YA, , Tawuyeb, HY,  Prevalence and factors associated with preoperative anemia among adult patients scheduled for major elective surgery at University hospital in Northwest Ethiopia; a cross-sectional study, Heliyon. 2022 Feb; 8(2): e08921.
  3. Skorupski CP, Cheung M, Lin Y, Preoperative anemia in major elective surgery. CMAJ. 2023 Apr 17; 195(15): E551.
  4. Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg. 2015; 102: 1314-24
  5. Ferraris VA, Hochstetler M, Martin JT, Mahan A, Saha SP. Blood transfusion and adverse surgical outcomes: The good and the bad. Surgery 2015 Sep;158(3):608-17
  6. Hare GMY, Mazer CD. Anemia: Perioperative Risk and Treatment Opportunity. Anesthesiology. 2021 Sep 1;135(3):520-530
  7. Spahn DR, Muñoz M, Klein AA, Levy JH, Zacharowski K. Patient Blood Management: Effectiveness and Future Potential. Anesthesiology 2020 Jul; 133(1): 212-222
  8. Leahy MF, Hofmann A, Towler S, et al. Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals. Transfusion 2017; 57(6): 1347–58
  9. Althoff FC, Neb H, Herrmann E, et al. Multimodal Patient Blood Management Program Based on a Three-pillar Strategy: A Systematic Review and Meta-analysis. Ann Surg. 2019 May; 269(5): 794-804
  10. Meybohm P, Richards T, Isbister J, et al. Patient blood management bundles to facilitate implementation. Transfus Med Rev. 2017; 31: 62–71
  11. Meybohm P, Schmitt E, Choorapoikayil S, et al; German Patient Blood Management Network Collaborators. German Patient Blood Management Network: effectiveness and safety analysis in 1.2 million patients. Br J Anaesth. 2023 Sep; 131(3): 472-481
  12. Maryuningsih Y, Abdella Y, Blumberg N, Bucagu M, Casal MNG, Beltran Duran M, et al. The urgent need to implement patient blood management: policy brief. In: Organization, W.H., editor. internet. Geneva: World Health Organization; 2021. https://apps.who.int/iris/bitstream/handle/10665/346655/9789240035744-eng.pdf
  13. Hofmann A, Spahn DR, Holtorf AP; PBM Implementation Group. Making patient blood management the new norm(al) as experienced by implementors in diverse countries. BMC Health Serv Res. 2021 Jul 2;21(1):634
  14. Rose J, Weiser TG, Hider P, Wilson L, Gruen RL, Bickler SW. Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate. Lancet Glob Health. 2015;3 Suppl 2: S13-20
  15. Jones JM, Sapiano MRP, Savinkina AA et al. Slowing decline in blood collection and transfusion in the United States – 2017. Transfusion 2020;60(suppl 2):S1-S9
  16. Zacharowski K, Spahn DR. Patient blood management equals patient safety. Best Pract Res Clin Anaesthesiol. 2016 Jun; 30(2): 159-69
  17.  Shander A, Hardy JF, Ozawa S et al. A Global Definition of Patient Blood Management. Anesth. Analg. 2022,135, 476–488

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