Patient Blood Management in Low-Middle Income Countries: Position, Preparations, Projections

Aim and objectives: This study aims to assess the status of knowledge, relevance, and feasibility of practices related to Patient Blood Management (PBM) in South Asian countries, i.e., India, Sri Lanka, Nepal, and Bangladesh. The key objective is to gauge the preparedness of healthcare professionals for the comprehensive and systematic implementation of practices and protocols related to Patient Blood Management. Background: In the last decade, there has been an increasing impulse to move beyond the "optimal use of blood" and implement PBM across the healthcare system. While there are ample guidelines and expert recommendations on clinical practices in developed countries, there is still a lack of competence, infrastructure, and resources required for the universal implementation of PBM. Material and Methods: An extensive survey was carried out by circulating a Google Form questionnaire among healthcare professionals from India, Sri Lanka, Nepal, and Bangladesh. Specialties approached were anesthesiologists, surgeons, intensivists, perfusionists, hematologists, and transfusion specialists. The responses to the questionnaire were automated and analyzed. Results: Of the 270 respondents, the majority were transfusion medicine specialists (45%) and anesthesiologists (36%). Most (54%) respondents believed that management strategies focus more on the utility of blood as a treatment method than managing the patient's blood. A substantial fraction (63%) admitted that blood transfusion was primarily preventive and "test- report responsive." The most significant fraction (72%) still believed that PBM is mostly about using blood optimally. Many (45%) considered the lack of evidence-backed regional guidelines as a limitation to bleeding management. Conclusion: The most significant barriers to successful and holistic implementation are the lack of a "multidisciplinary approach" and clear intent and direction from health policymakers and regulators. An important limitation is the paucity of infrastructure and human resources inherent to low- and middle-income countries.