Recommendations for implementing patient blood management-an updated modified Delphi consensus from a multidisciplinary expert panel in Hong Kong.

In 2020, the Hong Kong Society of Clinical Blood Management (HKSCBM) established a consensus statement on the implementation of patient blood management (PBM). Based on recent evidence on PBM initiatives and practices, the HKSCBM updated their consensus statements. HKSCBM convened a multidisciplinary panel of 13 experts, who formulated discussion questions across three PBM pillars: (1) optimising patients' red blood cell mass and improving anaemia management; (2) minimising perioperative blood loss; and (3) rationalising the use of blood and blood components. Using the modified Delphi method, the panel addressed the discussion questions by reviewing relevant literature and clinical experiences in multiple meetings. Consensus statements derived from meeting proceedings were voted anonymously by the panel. A consensus statement was accepted only if ≥ 80% of the panel chose 'accept completely' or 'accept with some reservation', based on a 5-point Likert scale. The panel accepted 117 consensus statements (including sub-statements). The updated version includes new additions to the following areas: identification of groups at high risk for iron deficiency anaemia; preoperative screening and management of iron deficiency and/or anaemia; recognition of bleeding-prone surgeries and conditions; recent measures to minimise intraoperative blood loss, including point-of-care coagulation testing, tranexamic acid, fibrinogen concentrate, reversal agents for anticoagulation, advanced haemodynamic monitoring, and uterotonics; suggested haemoglobin thresholds for transfusions; and implementation of transfusion protocols. These consensus statements are intended to serve as a practical framework for medical and surgical colleagues in Hong Kong and the Asia-Pacific region.