General Transfusion

Question 1

Strategies to minimise iatrogenic blood loss in children (10)

Answer 1

1. As needed rather than routine sampling
2. Senior to order tests
3. Batch testing i.e. do all tests on certain days
4. Minimise discard blood
5. Closed inline sampling devices
6. Return of void volumes to lines
7. POCT
8. Non-invasive testing
9. Laboratory to use minimal volume for testing
10. Audit compliance and cumulative phlebotomy losses

Question 2

What is patient blood management?

Answer 2

It is an evidence based, multidisciplinary and multimodal approach to optimise the use of blood products in hospital.
The goal is to improve patient outcomes without the unnecessary exposure to blood components.

Question 3

What are the three pillars of patient blood management?

Answer 3

1. Optimise blood volume and red cell mass and coagulation status
2. Minimise blood loss
3. Optimise patient’s tolerance of anaemia

Question 4

Discuss pre-operative patient blood management measures to reduce blood product use

Answer 4

Pre-operative scheduling of surgery should fit in with patient’s optimised Hb:

• see patient in clinic at least a month before surgery
• check FBC, if anaemic investigate and optimise (iron, B12, folate, renal function)
• check coags and review medications (anticoagulants, antiplatelet agents, chinese herbal meds etc)
• assess bleeding risk with surgery
• assess patient’s tolerance of anaemia and optimise

Question 5

Discuss intra-operative patient blood management measures to reduce blood product use (7).
optimise patient outcomes, reduce exposure to unnecessary blood components

Answer 5

1. Type of surgical technique - laparoscopic, robot devices, “hot scalpel”
2. Acute normovolaemia haemodilution
3. Controlled hypotension
4. Cell saver
5. Optimise temperatures, coags, pH, calcium
6. Intraoperative testing with TEG
7. Give TXA

Question 6

Post-operative techniques to minimise transfusion

Answer 6

1. Avoid over-sampling (iatrogenic blood loss)
2. Transfuse based on symptoms, not a number
3. Optimise iron status and fluid status post operatively