1.6 Blood Transfusions

Question 1

Minimise incorrect transfusion

Answer 1

Confirmation name dob Hospital number

Check compatibility blood group / expiry date

Remove >30mins - used in 4 hours

Accurate records - obs
temp during transfusion
timing
identity numbers - transfusion document

Ability to trace transfused blood products legal requirment - european blood directive

Question 2

What clinical parameters guide tfusion

Answer 2

1. Based Hb and situation
2. Estimate of Hb
   - abg
   - hemocue
   - lab results
3. Tfusion recommended
   -symptomatic tachycardia hypotension dizzy
   w clin or lab evidence

Hb 7 - essential <5 in healthy

Hb <8 in asymptomatic patients w cardiorespiratory disease

Question 3

Perioperative alternatives to tfusion

preop x 5

Answer 3

i pre op

1. Autologous
   blood collected 6 weeks preop store refridge used when required
2. Optimise RCC production
   folate iron epo b12
3. Optimise clotting
   vit K ffp
4. Stop anti-coag + anti platelet periop
   avoid nsaid antiplatelet

5 acute normovolamaeic haemodilution

Question 4

Intraoperative alternatives to tfusion

Answer 4

1. Cell salvage

blood collected specialise suction
filtered washed
tfused back

2. Regional technique -
   reduced blood loss
3. Surgeon
   skill / ability
4. Biological haemostatic materials - kaltostat surgicel
5. Pressure care + position
   - venous obstruction / htn
6. Minimise ooze
   avoid high intrathoracic pressure + hypercapnia vent
7. Maintain core body temp minimise hypothermia related coagulopathy
8. Optimise DO2
   - invasive monitor
   fluid
   inotropes
9. Anti fibrinolytic
   txa
10. Recombinant factor VIIa
11. Hypotensive anaes

Question 5

Postoperative

Answer 5

1. Ongoing care critical care
2. Invasive monitoring to guide therapy
3. Optimise DO2
4. Analgesia + sedation - avoid stress response agitation and pain
5. minimise venesection / abg samples