Evidence-Based Medicine: principles and values as illustrated by the case of Patient Blood Management


Blood is essential for many ill or injured people, after a traffic accident, surgery or childbirth, blood is needed every day. That is why the Belgian Red Cross continuously collects blood everywhere in Flanders and ensures that the supply of blood products (blood, plasma, platelets) in the health care system is kept at a constant level on a daily basis. Patient Blood Management (PBM) is a multidisciplinary, evidence-based and patient-centered approach to optimize the care of patients undergoing transfusion (blood, plasma, platelets). The pillars of PBM consist of blood-sparing techniques, a more restrictive transfusion policy, a better and faster treatment of anemia (e.g. in the preoperative phase), and the optimization of coagulation.

In a recent paper, we illustrated the principles of evidence-based medicine (EBM) using the case of PBM (i.e. treatment of preoperative anemia). Based on systematic reviews, we concluded that preoperative intravenous (IV) or oral iron monotherapy may not be effective to reduce red blood cell utilization (low-certainty evidence). Preoperative IV iron supplementation in addition to ESAs is probably effective to reduce RBC utilization (moderate-certainty evidence), whereas oral iron supplementation in addition to ESAs may be effective to reduce RBC utilization (low-certainty evidence). The adverse events of preoperative oral/IV iron and/or ESAs and their impact on patient-important outcomes (morbidity, mortality, quality of life) remain unclear (very low-certainty evidence). Since PBM is a systematic, evidence-based, patient-centered approach, these future research studies should be highly prioritized because guideline developers will consider patient-important outcomes (morbidity, mortality, quality of life) as the primary outcomes of interest when formulating recommendations. Future international PBM guideline initiatives are needed to translate the best available scientific evidence (EBM dimension 1) with the preferences and values of the transfused patient (EBM dimension 2), and the clinical expertise (EBM dimension 3).

The results of this paper were presented during the Pentalfa session of the Catholic University in Leuven (content in Dutch) and during the conference of the German Society for Thrombosis and Haemostasis Research (GTH, Frankfurt Am Main, 21-24 Feb 2023, Germany).