Regional
The first National patient blood management consensus statement launching in Malaysia
PBM, as defined by the Society of Advancement of Blood Transfusion (SABM), involves the “timely application of evidence-based medical and surgical concepts designed to maintain haemoglobin concentration, optimize haemostasis, and minimize blood loss to improve patient outcomes.”¹
In 2010, the World Health Organization (WHO) issued a policy brief emphasizing the urgent need for implementing Patient Blood Management (PBM) to enhance awareness and foster a sense of urgency among healthcare organizations.² By 2022, experts from several PBM organization from across the globe come together to develop a more clear & global definition of PBM which stated as: “Patient blood management is a patient-centred, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient’s own blood, while promoting patient safety and empowerment.”
Big smiles!
In Malaysia, the PBM movement began gaining attention in recent years, driven by various groups and individuals. However, the initiatives were fragmented and lacked central coordination. Clinical champions, exposed to PBM concepts through international conferences and networking, began applying these principles in their clinical practice. Professional societies such as the Malaysian Society of Blood Transfusion (MBTS), My PBM, and the Malaysian Cardiothoracic Anaesthesiology and Perfusion Society (MASCAP) have been actively promoting PBM through workshops, talks, and continuing medical education (CME) sessions. As a result, PBM awareness and activities were predominantly confined to hospitals with proactive clinical champions, leaving some institutions without PBM initiatives or activities.
Transfusion Medicine took a step forward to have a more collaborative approach among the different clinical disciplines by bringing them together in a two day PBM workshop on 12-13th October 2016 in National Blood Centre (NBC), Kuala Lumpur. The workshop was attended by 127 participants from multidisciplinary team including head of clinical disciplines and was inaugurated by Director of Medical Development Division from Ministry of Health, Malaysia. The event concluded with a forum addressing challenges and proposing strategies for implementing PBM nationwide. The successful engagement of influential individuals across various clinical fields marked the beginning of a systematic approach to PBM in Malaysia.
Full group photo
Following the workshop, the National Blood Centre, in collaboration with MBTS, embarked on a road tour across the country to raise awareness and identify clinical champions passionate about integrating PBM as a standard of care. Ongoing discussions with stakeholders, including the Medical Development Division of the Ministry of Health (MOH), led to the formation of the National PBM Committee in 2019. This committee comprises representatives from diverse clinical fields, private hospitals, and universities. Although PBM activities faced setbacks during the pandemic, momentum regained in 2022 with the organization of a workshop to develop the first National PBM Consensus Statement or guideline. Initially, seven groups of multidisciplinary experts were formed to draft the guidelines, with a nursing sub-module added later. We mainly emulate the guideline published by National Blood of Authority in Australia however, we also used other international guideline as references whenever necessary.
The consensus statement officially launched in Grand Pulse Hotel Putrajaya on 14th May 2024 and was attended by 112 participants. The event was officiated by Minister of Health Malaysia, Datuk Seri Dr. Dzulkefly Ahmad. The consensus statement was divided into eight sub modules which are Obstetrics & Gynecology, Perioperative, Neonatal & Pediatrics, Massive Hemorrhage, Cardiothoracic, Critical Care, Medical, and Nursing. These modules integrated PBM principles to encourage application across various clinical practices, serving as a foundational reference for comprehensive PBM implementation in Malaysia.
Dr. Mohammad Masrin bin Md Zahrin, NBC Director, in his opening remark emphasized the necessity to adopt evidence-based guidelines to assist clinicians in making informed decisions. Following this, speakers from different expertise were invited to present clinical cases applying Patient PBM principles. The event ended with a forum chaired by Datuk Seri Dr. Paras Doshi where panelists from all the submodules discussed ideas on PBM implementation and challenges in the country. Datuk Seri Dr. Dzulkefly Ahmad also contributed to the forum by sharing insights on clinical governance aspects relevant to PBM implementation.
Group photo
The development of the consensus statement exemplified a unified effort among clinicians from various disciplines to adopt PBM principles as a standard of care. This consensus will be periodically reviewed to incorporate the latest evidence and clinical practices.
The launch of the National Consensus Statement on PBM represents a significant milestone in Malaysia’s PBM implementation journey, garnering media attention and recognition from key stakeholders, including the Minister of Health. Although the path ahead remains challenging, the continued support from all involved parties is crucial for achieving a more systematic and comprehensive PBM practice across different disciplines.
Ultimately, the goal is to enhance patient outcomes by ensuring that PBM practices are adopted consistently and effectively throughout the healthcare system. This will require sustained effort and commitment from all stakeholders, including government bodies, healthcare institutions, professional societies, and individual clinicians. Through collective action and dedication, Malaysia can achieve its vision of a healthcare system that prioritizes optimal patient care through effective blood management strategies.
Acknowledgements
Dato Faraizah Binti Dato’ Abdul Karim, President of MBTS Afifah binti Haji Hassan, Vice President of MBTS Mohammad Masrin Bin Md Zahrin, Director of NBC Deputy Directors of NBC, Tun Maizura Mohd Fathullah & Nor Nazahah Mahmud & National PBM Committee.
References
1. Society for the Advancement of Blood Management (SABM) http://www.sabm.org
2. The urgent need to implement patient blood management: policy brief. 19 October 2021. Policy brief WHO
Shander, Aryeh MD, Hardy, Jean-Francois MD, Ozawa, Sherri RN, Farmer, Shannon L. DHSc, Hofmann, Axel Dr.rer.medic, Frank, Steven M. MD, Kor, Daryl J. MD, Faraoni, David MD, Freedman, John MD, Collaborators. A Global Definition of Patient Blood Management. Anesthesia & Analgesia 135(3):p 476-488, September 2022. | DOI: 10.1213/ANE.00000000000058733.
