Bleeding: You Don't Really Know It Until You Can Name It
Dr. Natalia Peres Martinez, MD, MSc, PhD, MBA, is a general surgeon and seasoned Medical Affairs Executive with a distinguished career in the medical device and pharmaceutical industries. With expertise spanning general surgery, cancer molecular biology, and Patient Blood Management (PBM), she brings a unique blend of clinical insight and strategic leadership. As one of the early collaborators with the Society for the Advancement of Blood Management (SABM), Dr. Peres Martinez champions the power of education, precision, and innovation in surgical care.
She reminds us that there is no better "hemostatic agent" in the operating room than the skilled, well-trained mind and hands of a surgeon, capable of diagnosing bleeding severity with clarity and using every available technology with purpose.
Question: Why is bleeding during surgery more than just a disruption?
Natalia: Bleeding is a pathological process, like infection or ischemia, with identifiable causes and measurable consequences. It affects outcomes and demands structured assessment and targeted therapy, not just reactive control.
Q: How is bleeding typically assessed in the OR, and what’s the problem with that?
Natalia: Visual estimation is still the most common method. But without structured training or a defined framework, it's highly inaccurate. Studies show deviations of 52–85% in estimated blood loss. This leads to inconsistent interventions, delayed hemostasis and unnecessary transfusions.
Q: What is Patient Blood Management (PBM), and why does it matter?
Natalia: PBM is a multidisciplinary approach to optimize hemoglobin, minimize blood loss and improve recovery. It relies on standardized, data-driven decisions to guide interventions. Accurate bleeding diagnosis is central to PBM success.
Q: Is there a better way to assess bleeding severity?
Natalia: Yes, the Validated Intraoperative Bleeding (VIBe) scale. Developed by surgeons and meeting FDA criteria, it grades bleeding severity (0–4) based on anatomy, flow and estimated loss per minute. Training with VIBe videos has shown reproducible and reliable classification.
Q: How does the VIBe scale improve safety and communication?
Natalia: It replaces vague terms like "it's bad" with precise grades like "Grade 3 bleed." This shared vocabulary supports structured hemostatic decisions, PBM documentation and device evaluation, enhancing coordination and safety in the OR.
Q: Why should surgeons care about bleeding precision?
Natalia: Because precision saves blood, time and lives. Accurate diagnosis enables targeted intervention. Graded documentation fuels benchmarking and innovation. Without validation, progress is stalled even in bleeding management.
Q: What’s the bottom line?
Natalia: Treat bleeding as a diagnosable disease, not just an episode. This shift, from reaction to precision, advances PBM, improves safety, and drives innovation. The future belongs to those who stop guessing and start knowing.