Patient blood management

Question 1

Reasons for having a blood std

Answer 1

• Demand > Supply
• many inappropriate transfusions
• minimise wastage bc Expensive
• Inc risk of morbidity & mortality

Question 2

Describe how ROTEM is used to guide administration of blood products in the bleeding patient.

Answer 2

• Coagulation testing on whole blood
• guide to haemostatic agents

Question 3

Briefly describe the alternatives to transfusion that are used as part of perioperative patient blood management.

Answer 3

• Cell salvage: uses pt’s own fresh RBC in OT
• Acute Normovolemic haemodilution: Blood collected from pt pre-op in OT & given saline to maintain BV

Question 4

The purpose of he preoperative tests:
a) FBP
b) Iron studies inc Ferritin
c) CRP & renal function

Answer 4

a) check is pt is anaemic
b) Differentiate b/w IDA & ACD - check on Fe stores
c) CRP confirms that Hi ferritin is not due to an infection (elevated)

Question 5

What is Cell salvage

Answer 5

• uses pt’s own fresh RBC
• Return vol of blood lost
• Reduce exposure foreign RBC
• acceptable to ppl who refuse to receive other blood
• only gives RBC

Question 6

What is Acute Normovolaemic haemodilution

Answer 6

• Blood collected from pt pre-op in OT & given saline/Alb. to maintain BV
• blood reinfused as needed
• Reduce risk of HTR
• Gives RBC, plasma & plts

Question 7

What is systemic tranexamic acid?

Answer 7

• lysine analogue
• inhibts fibrinolysis when binds to fibrin binding site of plasminogen = clot
• used for significant bleeds

Question 8

Describe the methods that minimise and reduce blood loss (5)

Answer 8

• Systemic tranexamic acid: Inhibits fibrinolysis = clot
• Topical sealant: allows clot formation (thrombin,fibrinogen) & inhibit fibrinolysis (aprotinin)
• controlled hypotension = dec BP = control blood loss
• patient positioning
• Avoid hypothermia: bc blood coag less efficient

Question 9

What are the cut of values that indicate a pt will need to be transfused with which product
a) Hb
b) Plts
c) PT/aPTT
d) Fibrinogen

Answer 9

a) Hb: 70-90g/L = blood
b) Plt: <50x 10^0 /L = plt
c) PT/aPTT: >1.5x normal = FFP
d) Fib: <1g/L (or <2g/L) = Cryo

Question 10

What’s recombinant factor VIIa & when is it required?

Answer 10

• Binds to tissue factor => thrombin generation
• Only used in life-threatening bleeding & NOT due to haemostatic tech/products
• Thrombotic risk