Implementing first pillar of PBM in the Emergency Area: a missed opportunity?

Abstract

Anemia is a common condition in emergency care, with a significant proportion of patients presenting with low hemoglobin levels. Despite clinical guidelines promoting a more restrictive approach to blood transfusion, many transfusions remain inappropriate. This is often due to the use of incorrect hemoglobin thresholds or failure to address underlying causes, such as iron deficiency. Excessive use of transfusions exposes patients to avoidable risks, including circulatory overload and other transfusion-related complications.

The first pillar of Patient Blood Management aims to reduce the need for transfusions through early detection and targeted treatment of anemia. In patients with iron deficiency anemia, an effective strategy is the administration of intravenous iron, which allows for rapid and sustained increases in hemoglobin even in cases with severe anemia. This approach reduces reliance on transfusions, shortens hospital stays, and lowers healthcare costs. While the efficacy of intravenous iron is well established, its application in emergency care is often limited, highlighting the need for structural changes and improved clinical practice.

A promising solution is the establishment of anemia clinics within emergency departments. These clinics facilitate rapid diagnosis, early treatment and comprehensive follow-up care. This model supports more efficient use of healthcare resources by reducing transfusions, minimizing hospital admissions, and alleviating the strain on emergency department capacity. Additionally, it offers long-term benefits for chronic anemia management, promoting a patient-centred approach that aligns with Patient Blood Management principles.

The implementation of anemia clinics in emergency care presents a valuable opportunity to fully realise the first pillar of Patient Blood Management, optimising patient care and healthcare efficiency. Addressing this gap could improve patient safety, reduce healthcare costs, and promote the sustainable use of limited blood supplies. Greater awareness, education, and system-wide changes are required to embed this evidence-based approach into emergency care workflows.