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Written by: Golden Chess
2020-08-17 06:00
Last update date: 2020-08-17 06:00The third wave of the novel coronavirus pneumonia epidemic in Hong Kong continues. Many blood donations have been cancelled and blood banks have been in emergency. Medical organizations concerned about blood issues have published papers suggesting that “Patient Blood Management” (PBM) be implemented in Hong Kong hospitals, which means increasing patient hemoglobin and reducing bleeding in the three stages before, during and after surgery, which can reduce The blood transfusion rate, the risk of complications, and the shortening of hospital stays can also reduce Hong Kong’s dependence on blood.
In Tseung Kwan O Hospital, PBM was implemented on a trial basis in 2015, and the blood transfusion rate for colorectal tumors was reduced from 33.3% to 11.3%. The anesthesiologist of the hospital suggested that citizens can eat iron-rich foods daily, such as red meat, spinach and other foods to supplement iron. The doctor also emphasized that "blood transfusion can not make up for the body, it has harm and no benefit." It may affect the patient's immune system or cause the body to decline.
The Hong Kong Society of Clinical Blood Management published a study on PBM. (Photo by Huang Baoying)
The blood consumption rate in Hong Kong is higher than Australia and the Netherlands
The blood consumption rate in Hong Kong has been high. In 2016, every 1,000 people in Hong Kong used 25 to 30 packs of blood, which is higher than Australia and the Netherlands, which use 20 to 25 packs a year. The Hong Kong Society of Clinical Blood Management today (17th) published a study on PBM. The chairman of the Society, Zhou Yufa, pointed out that the aging population in Hong Kong continues to increase the demand for blood, but the number of blood donors is decreasing. The current novel pneumonia epidemic has exacerbated the shortage of supply. If the hospital implements PBM and reduces the patient's blood transfusion rate, it can reduce the dependence on blood products. "Blood is valuable and needs to be used properly."
Xu Qianrui, associate consultant of the Department of Anesthesiology and Intensive Care at the Prince of Wales Hospital, explained that PBM is divided into three stages before, during and after the operation. Before the operation, patients and citizens should consult a doctor if they have symptoms of anemia such as fatigue or dizziness. To improve the situation as soon as possible. In addition, you should eat more vitamin A and C foods daily to help absorb iron; and more aerobic exercises can also help restore and reduce bleeding. For patients who are about to undergo surgery, it is recommended to take iron supplements directly orally or intravenously.
During the operation, the team will cautiously use hemostasis methods to reduce bleeding during the operation; and will maintain the patient's normal body temperature so that the body's hemostasis function can perform best. After the operation, the physiotherapist will assist the patient to perform appropriate aerobic exercises, with assistants to recover after the operation, reduce bleeding and complications.
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Tseung Kwan O Hospital's colorectal tumor surgery blood transfusion rate drops by two thirds
Tseung Kwan O Hospital began to trial PBM and a comprehensive program to promote postoperative recovery in November 2015. The hospital's consultant anesthesiologist, Zheng Hongjia, said that the first batch of patients undergoing colorectal tumor surgery was tested. As of June 2017, a total of 168 patients tried the program. The hospital stay of these patients was half shorter than that of patients who did not try PBM, and they could be discharged in only four days; their blood transfusion rate also dropped from 33.3% to 11.3%, a reduction of two-thirds.
Zheng also pointed out that many patients may think that blood transfusion is not harmful to the body. "Old people ask doctors to help transfusion, and think it can make up for themselves." However, he emphasized that the blood transfused is not produced by his own body and is more likely to contain viruses. After blood transfusion, inflammation may occur after surgery, and it may even lead to deterioration of body functions, such as kidney failure, respiratory failure, etc.; cancer patients without blood transfusion during surgery have a lower risk of complications.
Zheng Hongjia: Earn money for the hospital as a whole
In addition, Zheng Hongjia said that all surgeries are also suitable for PBM, but it is more cost-effective to perform surgeries with heavy bleeding. Tseung Kwan O Hospital also expanded PBM to orthopedics and obstetrics and gynecology, such as hysterectomy. Regarding the manpower problem of the pilot PBM hospital, Zheng pointed out that investing in manpower and material resources for PBM can shorten the length of the patient's hospital stay, etc. "In the future, fewer patients will return to the hospital, which will benefit the hospital as a whole."
When asked about the early implementation of PBM in foreign countries, why does Hong Kong have this initiative now? Zhou Yu laughed and said that the reason was "The Hong Kong Red Cross has done too well and its driving force is not strong."
Related papers were published in the "Hong Kong Medical Journal" today, which coincides with the magazine’s 25th anniversary this year. The editor-in-chief of the magazine Huang Zhisheng pointed out that all the contents of the magazine can be browsed for free online, and the magazine "Impact Factor" is also It rose from 0.872 to 1.689 in five years, reflecting that there are many high-quality articles.
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Hong Kong Medical Journal of Tseung Kwan O Hospital