SHM Converge Scientific Abstract ePoster Gallery-Streamlining Bloodless Care: The Impact of Protocol-Driven Management in a Case of Severe Anemia

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This case report describes the use of a protocol-driven patient blood management (PBM) approach in a 75-year-old woman with severe anemia and gastrointestinal bleeding who presented with melena, weakness, and epigastric discomfort. She had a history of duodenal ulcer and hepatitis C. Although initially hemodynamically stable, her hemoglobin fell from 6.1 g/dL to 4.7 g/dL after fluid resuscitation. Iron studies suggested iron deficiency or functional iron deficiency, and CT angiography showed no active hemorrhage but did reveal a large hiatal hernia.<br /><br />Because the patient required bloodless management, treatment focused on preserving blood, stimulating red blood cell production, and improving oxygen delivery. Interventions included limiting blood draws every 3 days and using smaller tubes to reduce iatrogenic blood loss. She was treated with subcutaneous epoetin alfa 20,000 units twice daily, IV iron sucrose 200 mg daily for 5 days, vitamin B12 1000 mcg once, and folic acid 1 mg IV daily. Additional supportive measures included supplemental oxygen, activity restriction, and daily EKG monitoring for signs of tissue hypoxia. Endoscopic evaluation was also part of her management.<br /><br />The discussion highlights the core principles of PBM: minimizing blood loss, enhancing erythropoiesis, and optimizing oxygen transport. The authors conclude that careful bloodless management can achieve outcomes similar to standard care and may even reduce hospital costs. They also emphasize that establishing a PBM committee at their institution helped create an accessible bloodless protocol, enabling early and strategic intervention across physicians and improving patient care.

Asset Subtitle

Karishma D. Narain

Meta Tag

Author List Dipal R. Patel, Karishma D. Narain, Namratha Pallipamu

Category Clinical Vignettes

Concept Patient Blood Management

Concept Severe Anemia

Concept Blood Loss

Concept Red Blood Cell Production

Concept Oxygen Delivery

Distinguished Non-Finalist

Presenter Organization Englewood Health

Presenting Author Karishma D. Narain

Track Adult

Keywords

patient blood management

PBM

severe anemia

gastrointestinal bleeding

bloodless management

epoetin alfa

intravenous iron

iron deficiency

iatrogenic blood loss

endoscopic evaluation

Patient Blood Management

Severe Anemia

Blood Loss

Red Blood Cell Production

Oxygen Delivery