W3 LECT 3: PBM and ethics of blood transfusion

Question 1

what is global health?

Answer 1

An area for study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide

Question 2

what is health equity?

Answer 2

Health equity is achieved when every person
* has the opportunity to “attain his or her full health potential” and
* no one is “disadvantaged from achieving this potential because of
social position or other socially determined circumstances.

Question 3

what are the negative impacts of iron defeciency?

Answer 3

• Extreme fatigue & Weakness
• Chest pain, fast heartbeat or shortness of breath
• Headache, dizziness or light-headedness
• Inflammation or soreness of your tongue
• Brittle nails, Pale skin, Cold hands and feet
• Unusual cravings for non-nutritive substances, such as ice, dirt or starch

Question 4

what are the negative impacts of ID on pregnancy?

Answer 4

• Breathing difficulties, fainting, tiredness, palpitations, sleep difficulties.
• Increased risk: Perinatal infection, Pre-eclampsia,
  Bleeding, Post-partum cognitive impairment, Behavioural difficulties.
  Foetal brain requires iron for normal development

Question 5

what are the negative impacts of ID on perinatal period

Answer 5

IUGR,
Prematurity,
LBW – all with significant morbidity / mortality risks.

Question 6

what is patient blood management?

Answer 6

• PBM is an evidence-based, multi-disciplinary approach to optimizing the care of patients who may need transfusions.
• Covers all aspects of patient evaluation and clinical management
  surrounding the transfusion decision-making process.
• This includes:
• Application of appropriate indications,
• minimizing blood loss and
• optimizing the patient’s red blood cell mass

Question 7

function or concept of pbm is to?

Answer 7

• maintain hemoglobin concentration,
• optimize hemostasis and
• minimize blood loss

Question 8

what are the core focus pionts of pbm?

Answer 8

• diagnosis and treatment of anaemia
• minimize blood loss
• patient’s physiological reserve
• Patient empowerment
• Multi-disciplinary

Question 9

what are the 3 pillars of PBM?

Answer 9

• anaemia iron deficiency
• transfusion
• blood loss bleeding

Question 10

what are the PBM measures?

Answer 10

• Screen for, diagnose and
  optimally treat iron
  deficiency and anaemia in
  ALL patients.
• Correct pre-op anaemia
• Do not treat pre-op anaemia
  with red cell transfusions.

Question 11

what is pre- operatve anaemia?

Answer 11

is a condition where a patient has a lower than normal number of red blood cells or hemoglobin levels before undergoing surgery

Question 12

what are the neg. effects of pre- op anaemia?

Answer 12

• Mortality, Morbidity
• Length of hospital stay
• Exposure to transfusions

Question 13

what is autonomy?

Answer 13

The capacity of a rational , competent individual to make an informed, uncoerced decision.
* Competent adults have the right to decide what will/ will not be done to their bodies.
In transfusion…
* Informed consent:
- informed refusal

Question 14

what is beneficence

Answer 14

Duty to act to the benefit of the patient.
* Promote patient welfare.
* Beneficent actions can help to prevent harm and remove conditions
that may cause harm.

Question 15

apply befeficence in transfusion?

Answer 15

In transfusion…
* Transfusion must be based on a genuine clinical need.
* If, post-transfusion information becomes available of possible/potential/probable harm,
the patient must be informed = Lookback Program.
* Information concerning the transfusion received, must remain confidential.
* Do not limit your patient’s options. (Patient Blood Management principles!)

Question 16

what is non- maleficence?

Answer 16

To “do no unnecessary or unreasonable harm”.
* Do not expose patients to unnecessary risks.
* Do not deprive others from the goods of life.
In transfusion…
* Transfusions must be based on a genuine clinical need.
* Weigh benefits and risks and choose the best course of action for the patient.
* Unnecessary transfusions / products
* Inadequate knowledge of treatment
* Standard of care

Question 17

what is justice?

Answer 17

Equitable distribution of benefits and burdens to individuals / social institutions.
* Fair, equitable and appropriate treatment of all patients.
In transfusion…
* Patients should be treated equitably for the same healthcare condition.
* Medical decisions relating to transfusion should be based on best available evidence
and treatment – adapted to local circumstances.
* Patient should receive the most appropriate blood products available.
* Patient should only receive those products that are clinically appropriate and will afford
optimal outcomes and safety.
* Wastage of a scarce resource may impact on the greater patient population.

Question 18

why do we need pbm?

Answer 18

1. Anaemia: The common, silent enemy
2. Mitigate transfusion risk
3. Optimize patient outcomes
4. Provide cost-effective healthcare