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

Résumé fourni par la source

Emergency Areas (EAs) are typically characterized by high levels of overcrowding, ref lecting their critical role within healthcare systems.In Europe, EAs register an average of 250 visits per 1,000 inhabitants annually 1 , while in the United States, this figure rises to 427 2 , underscoring the significant demand placed on these services.Within this substantial patient burden, a significant proportion of individuals access EAs following a diagnosis of anemia or due to anemia-related symptoms, while in other cases, anemia is incidentally detected during admission for unrelated medical conditions.Two key studies have highlighted its prevalence, reporting rates of 27.5% when applying the World Health Organization (WHO) criteria 3 and 45.8% when using a definition of hemoglobin (Hb) levels below 12.0 g/dL 4 .These findings emphasize the relevance of addressing anemia in this critical healthcare context.A crucial aspect of anemia management in EAs is the appropriateness of red blood cell (RBC) transfusions.While transfusion is often perceived as an immediate solution for anemia correction, evidence suggests a significant proportion of them in EAs are inappropriate.Approximately one-third of RBC transfusions have been shown to be misaligned with established clinical guidelines, either due to inadequate Hb thresholds or neglect of the underlying pathology, such as iron deficiency anemia (IDA) without cardiovascular instability 3,5-7 .These results underscore the persistent knowledge-to-practice gap regarding the application of Patient Blood Management (PBM) 8 principles in EAs, particularly when alternative treatments, such as intravenous (IV) iron, may be more appropriate in many cases.A decision tree algorithm aimed at improving transfusion appropriateness in chronic anemia was proposed by Beverina et al. 9 (Figure 1).An additional reason of transfusion inappropriateness is related to the volume of RBCs administered, leading to post-transfusion Hb levels that exceed therapeutic targets.Over transfusion is a critical aspect of transfusion management because it exposes patients to avoidable risks, such as transfusion-associated circulatory overload (TACO) and other complications.Evidence from EAs has shown that the rate of volume inappropriateness ranges from 16 to 91%, ref lecting the widespread nature of this issue 3,5,6,10 .This highlights the need for stricter control of transfusion volume and the implementation of strategies such as single-unit transfusion policies and routine post-transfusion Hb reassessment 11 .In addition to the well-known immediate and delayed adverse effects associated with RBC transfusions 12 , it is essential to acknowledge that blood is a finite resource.

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