AFJOG

African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 3 | 2024 | 38 WHY DO WE NEED TO IMPLEMENT PBM? There are several well-documented reasons why the implementation of PBM should receive attention – and even be fast- tracked – in South Africa. Anaemia The global burden of anaemia in 2015 was estimated at ~ 2.4 billion, with iron deficiency anaemia accounting for ~ 1.5 billion of these cases. The negative impact on quality of life due to iron deficiency is well described in the literature and the negative impact on pregnancy outcomes and the cognitive development of children is receiving increasing attention. In South Africa, at least 2 studies have demonstrated the high prevalence of anaemia in elective surgery (47.8%) and pregnant patients (42.7%). The presence of pre-operative anaemia was also independently linked to poorer patient outcomes (increased morbidity and mortality) in both the South African and several other studies. Correcting pre-operative anaemia should be a priority, according to the South African Society of Anaesthesiologists as well as several international sources. Mitigate Transfusion Risks While an appropriate transfusion still remains a life-saving intervention, no transfusion is without risk. Transfusion risks are per product transfused, rather than per transfusion episode. The adverse events related to transfusion, their negative impact on clinical outcomes in certain patient populations and the association between negative clinical outcomes and high-dose transfusions are well described in the literature. Clinically inappropriate transfusions should be avoided at all times. Improved Patient Outcomes Several publications have shown improved outcomes (15% – 31% improvement) when implementing effective PBM programmes. Outcomes include: • Decreased exposure to allogeneic red cells • Decreased transfusion-related adverse events (TRAEs) • Decreased length of hospital stay • Decreased intensive care unit (ICU) admissions • Decreased serious morbidity, e.g. infectious and thrombotic complications • Decreased in-hospital mortality By applying PBM principles to our daily decision-making processes, we will ensure that the right product reaches the right patient at the right time for the right reason – resulting in optimal patient outcomes. Cost-Effective Healthcare Delivering cost-effective healthcare is imperative for all role-players in a resource-constrained setting. PBM can be a valuable tool to achieve this goal in South Africa as the implementation of effective PBM programmes has been demonstrated to reduce not only the “blood bill”, but also overall transfusion-associated costs. The cost of PBM interventions (cell salvage, iron supplementation, etc.), can be off-set against the lower transfusion rates, with literature showing that improved patient safety can be achieved in a cost-effective manner.