Management Of Major Haemorrhage

Question 1

When should the major haemorrhage policy H-15 be used?

Answer 1

In critical bleeding patients OR patients with anticipated need for massive transfusion

Question 2

Major haemorrhage is defined as…

Answer 2

Bleeding which leads to HR more than 110 bpm and/ or systolic BP less than 90mmHg (but use clinical judgement)

Also:
Replacement of half of blood volume in 3 hours
A blood loss of more than 150mls/min or a drop of 40g/l

Question 3

How do you activate the major haemorrhage policy?

Answer 3

Call/bleep blood bank
Should be a senior clinician who makes decision to activate the MHP but a competent qualified member of staff e.g nurse/ODP can make call to blood bank
Make sure clear of needs, use the phrase: “I want to trigger the major haemorrhage policy”

Question 4

On activation blood bank will tell you if they require…

Answer 4

Any group and save samples - if required, must be taken before administration of blood products

Question 5

Once activated, what will BB prepare?

If group and save available

Answer 5

4xRBCs
2xFFP/Octoplas
1xplatelets
2xcryoprecipitate if fibrinogen level less than 1.5g/L

Thereafter must inform BB of product requirements

Question 6

What happens if no group and save available?

Answer 6

4x O Rh neg red cells uncross matched ready immediately in pathology blood fridge
2 x suitable FFP/Octoplas ready in 30 mins from activation in first instance
1x platelets
2 x cryoprecipitate

Question 7

What monitoring should be done frequently?

Answer 7

Hb and platelets
Clotting screen
Fibrinogen level

Question 8

Should all checking procedures still be undertaken?

Answer 8

Yes