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Protecting Patient Outcomes Through Patient Blood Management

We caught up with anesthesiologist and critical care specialist Matthew Warner, MD, who leads patient blood management and anemia management at the Mayo Clinic, to find out how focusing on anemia and patient blood management profoundly impacts healthcare.

Dr. Warner was always interested in science and the natural processes that sustain life on earth, including disciplines like biology, physics, and chemistry. As an undergraduate, he traveled to Panama to conduct research as part of a professor-led team. That experience crystallized his enthusiasm. I was hooked on science. I was hooked on research, and I love that part of the world. So, I spent the next two years basically traveling around Central and South America, doing research and living in fantastic places. And it was during this time that I actually had my first exposure to a hospital setting.

He first had experience as a patient, and then as a volunteer, at a hospital in coastal Ecuador. He knew then that medicine was his path. I loved it, and I wanted to connect with patients. After I returned to the United States, I applied for medical school.

The field of anesthesiology combined three of his favorite aspects of medicine: a focus on physiology, the direct patient care environment epitomized by critical care, and the opportunity to conduct impactful research. Anesthesiology proved to be the perfect fit.

Importance of patient blood management

Dr. Warner’s interest in patient blood management emerged when he became aware of the logical fallacy behind red-cell transfusions for the treatment of anemia. That fallacy is rooted in the concept that red blood cells are the primary delivery vehicles for oxygen throughout the body. And hence, if we give more red blood cells to a patient and try to maintain a normal hemoglobin concentration with them, we could potentially improve oxygen delivery to tissues and improve patient outcomes. But we've learned that, that's not the case. There have been landmark transfusion trials, and it's obvious that this notion of giving transfusions to optimize patient outcomes is flawed. 

Despite this flawed practice, liberal transfusion practices were still the norm during his medical education. He found a mentor in Dr. Daryl Kor, who was an anesthesiologist and ICU physician at the Mayo Clinic and had recently taken over the Mayo Clinic’s patient blood management program. I hitched my wagon onto his given our shared interest in transfusion management, and since that time, we've really worked together collaboratively over the last 10 years. He's my close friend. He's a great mentor for me. And together, we currently co-direct the patient blood management efforts at the Mayo Clinic.

Dr. Warner is currently the director of the Mayo Clinic blood management subcommittee, a multidisciplinary committee consisting of physicians, administrators, nurses, and transfusion medicine specialists that are charged with ensuring transfusion safety and congruence with the health system’s patient blood management practices and institutional objectives. As part of that, we have a day-to-day team that assures all patient blood management activities are being performed appropriately throughout our hospital, which I co-direct with Dr. Kor. I'm also the director for the Mayo Clinic preoperative anemia clinic and the director for our bloodless surgery and medicine program here at the Mayo Clinic.

 

Setting the standard for patient blood management and anemia management

Anemia and blood health in general are extremely important for patient outcomes, and the concept of patient blood management revolves around improving patient outcomes. Anemia and blood health have important implications for blood patient outcomes directly, in and of themselves, and in the sense that abnormalities in our hematologic status increase our risk for allogeneic transfusions, which has adverse downstream consequences.

Yet, anemia and other aspects of blood health have traditionally been ignored as necessary consequences of medical care. To Dr. Warner, ignoring it is tantamount to ignoring any other instance of patient harm. For example, we know that hospitalized patients tend to become anemic, but since transfusion may make them worse; we often simply tolerate the anemia. But instead of tolerating it, what we really are doing is ignoring anemia and accepting that our hematologic system is collateral damage in our current vision of proper medical care. To me, it’s a completely backwards way of thinking.

Instead, Dr. Warner takes a proactive approach to avoid the patient injury that results from ignoring anemia. We work to identify why it's occurring. We take corrective actions to ensure that we are tightening the ship. There's mounting evidence that anemia is far from benign, and it may have lasting consequences on the function of our hospital survivors and in the greater community.

Finally, health systems should rethink their approach to transfusions and focus on decreasing the reliance on allogenic blood products. Transfusion therapies have traditionally been utilized as a treatment for anemia and perturbations in blood health. And while they certainly have their place, and transfusions can be lifesaving for patients with a massive hemorrhage, we know that allogeneic transfusions are expensive, they're susceptible to critical shortages, and they're associated with adverse clinical outcomes.

 

Career highlights

Working in the ICU, Dr. Warner gets to make a real impact every day. There's been much tragedy in that environment, but there's also been incredibly moving and powerfully positive moments, even those associated with very difficult decisions and end-of-life care. So, it's hard to say one moment's more impactful than another, but every day, caring for patients is impactful for me.

Patient blood management is one of the keyways Dr. Warner is able to make that impact in his clinical practice. Some of the most impactful moments in my career have been taking patients that have been denied, for example, surgical or procedural interventions at other institutions because they're deemed to be too high risk from a blood loss perspective and working in a multidisciplinary fashion to get them the care they need. Whenever we care for those types of patients, it just leaves a tremendous impact on me that when we work together, and when we're smart in how we approach things from a blood management perspective, we can truly improve outcomes for patients and improve lives.

 

Three ways to profoundly impact healthcare

Dr. Warner seeks to profoundly impact healthcare on three levels. First, he focuses on taking great care of patients in his clinical practice. Every day, I have the absolute honor to take care of patients. Patient care remains at the heart of why I'm in medicine, and it's truly a way that I can impact patients on a very individual and personal level. 

Secondly, he impacts healthcare by helping to train the next generation of physicians. Every day, I'm involved in educating the next generation of clinicians and scientists, helping them to be better than I am and to carry the torch forward. Thirdly is a focus on clinical and translational research. I continue to do research evaluating the long-term consequences of anemia in our hospitalized patients, particularly in survivors of critical illness.  

COVID-19’s effect on patient blood management

The pandemic re-centered health systems’ focus on blood products as a resource that can run out. We had a lot of decreases in blood donations and collections early on in the pandemic, which led to some critical shortages. We're still feeling many of those blood shortages in many parts of the country. Patient blood management is a way that makes sense for our institutions and for our patients to rethink our use of blood supplies. Let's do everything we can to prevent our patients from needing transfusion therapies. Let's optimize their hematologic status, the best we can. Coming out of COVID-19, I hope that we're able to keep that momentum and that focus on the importance of patient blood management, and to extend that importance to other institutions and hospitals that might not have dedicated patient blood management programs.