Blood Transfusion Flashcards
Anaemia in pregnancy by trimester and PP
1st: Hb<110
2nd: Hb<105 (and 3rd trime)
PP < 100
When to screen for anaemia
Booking
28 weeks
When to offer IV iron therapy
Oral iron not tolerated or absorbed
Poor patient compliance
Nil time for oral to be effective before term
When to have cell salvage
Anticipate high volume blood loss to induce anaemia or expected to exceed 20% of estimated blood volume
If they are Rh-, need 1500IU anti-D after reimbursing salvaged cells
When to give FFP
12-15 ml/kg for every 6 units RBCs during major obstetric haemorrhage
(After 4 units of blood)
After that- aim to maintain prothrombin time and APTT ratios at <1.5 x normal
When to give cryo
Give early in major obs haemorrhage
Standard dose of two 5-unit pools
Fibrinogen <2
When to give playlets
75
Aim to maintain platelets count >50 in the acutely bleeding patient
How current does G&S need to be
3 days
If ongoing potential for need, can be every 7 days
When to give RBCs
No firm criteria
Always give if < 60
Rarely required if >100
Fibrinogen level associated with increased risk of PPH
2.9 g/L
When can use Factor VIIa
Inherited bleeding disorders
Outside of this —> increased risk of arterial thrombosis
TXA mechanism of action
Synthetic derivative of lysine that reversibly binds to the lysine-binding sites of the plasminogen molecule
Prevents activation of plasminogen to plasmin —> leading to inhibition of fibrinolysis
Prothrombin time/activated partial thromboplastin time >1.5 x normal with ongoing haemorrhage
Need more FFP 15ml/kg
Fibrinogen level to maintained
> 2g/L
If less than, give cryo
Main therapeutic goals f the management of massive haemorrhage
Hb >80 Platelet >50 PT <1.5x normal APTT <1.5 x normal Fibrinogen >2
