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REVIEW ARTICLE
Year : 2021  |  Volume : 37  |  Issue : 1  |  Page : 3-13

Patient blood management in India - Review of current practices and feasibility of applying appropriate standard of care guidelines. A position paper by an interdisciplinary expert group


1 Head – Clinical Affairs, Instrumentation Laboratory India Pvt Ltd, New Delhi, India
2 Medical Director, TEM Innovations/PBM Instrumentation Laboratory, Munich, Germany
3 Department of Transfusion Medicine and Immunohematology, Christian Medical College, Vellore, Tamil Nadu, India
4 Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
5 Department of Anaesthesiology, Pain Medicine and Critical Care, In Charge Trauma Intensive Care Unit and Trauma Anaesthesia, JPN Apex Trauma Centre, New Delhi, India
6 Department of Cardiac Anaesthesia, Medanta the Medicity, Gurugram, Haryana, India
7 Department of Laboratory Medicine, BLK Superspeciality Hospital, New Delhi, India
8 Department of Cardiac Anaesthesia, Fortis Escorts Heart Institute, New Delhi, India
9 Department of Haematology, Sir Gangaram Hospital, New Delhi, India
10 Department of Haematology and Bone Marrow Transplant, Christian Medical College, Ludhiana, Punjab, India
11 Department of Clinical Haematology, Sahayadri Hospital, Pune, Maharashtra, India
12 Department of Liver Transplant Anaesthesia, Medanta the Medicity, Gurugram, Haryana, India
13 Medical Director and Head, Laboratory and Blood Bank, Santokhba Durlabhji Hospital, Jaipur, Rajasthan, India
14 Department of Transfusion Medicine, Medanta the Medicity, Gurugram, Haryana, India
15 Department of Liver Transplant Anaesthesia, Max Superspeciality Hospital, New Delhi, India
16 Department of Obstetrics and Gynaecology, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Correspondence Address:
Dr Ajay Gandhi
Clinical Affairs, Instrumentation Laboratory India Private Limited. 1471-76, Agrawal Millennium Tower II, Plot Number E-4, Netaji Subhash Place, Pitampura, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joacp.JOACP_410_20

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In a developing country like India, with limited resources and access to healthcare facilities, dealing with massive hemorrhage is a major challenge. This challenge gets compounded by pre-existing anemia, hemostatic disorders, and logistic issues of timely transfer of such patients from peripheral hospitals to centers with adequate resources and management expertise. Despite the awareness amongst healthcare providers regarding management modalities of bleeding patients, no uniform Patient Blood Management (PBM) or perioperative bleeding management protocols have been implemented in India, yet. In light of this, an interdisciplinary expert group came together, comprising of experts working in transfusion medicine, hematology, obstetrics, anesthesiology and intensive care, to review current practices in management of bleeding in Indian healthcare institutions and evaluating the feasibility of implementing uniform PBM guidelines. The specific intent was to perform a gap analysis between the ideal and the current status in terms of practices and resources. The expert group identified interdisciplinary education in PBM and bleeding management, bleeding history, viscoelastic and platelet function testing, and the implementation of validated, setting-specific bleeding management protocols (algorithms) as important tools in PBM and perioperative bleeding management. Here, trauma, major surgery, postpartum hemorrhage, cardiac and liver surgery are the most common clinical settings associated with massive blood loss. Accordingly, PBM should be implemented as a multidisciplinary and practically applicable concept in India in a timely manner in order to optimize the use the precious resource blood and to increase patients' safety.


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