Surgery (other)

Question 1

What are you asking yourself before a blood transfusion?

Answer 1

Can I minimize blood loss?
Are there other treatments I can give?
What improvement am I aiming to achieve?
Has the patient been given a clear explanation of the risks and benefits?

Question 2

What are the causes of small bowel obstruction?

Answer 2

H - Hernia
A - Adhesions
V - Volvulus
I - Intussusception
T - Tumour

Question 3

What are the causes of gynaecomastia?

Answer 3

C - Cirrhosis
O - Obesity
D - Digoxin
E - Estrogen
S - Spironolactone

Question 4

What are the RFs for adverse outcomes?

Answer 4

Anaemia (Iron deficiency), Transfusion, blood loss and bleeding

Question 5

Three pillars of Blood management?

Answer 5

Optimize Red cell mass
Minimize blood loss and bleeding
Harness and optimize physiological reserve of anemia

Question 6

What are the causes of Iron deficiency (broard)?

Answer 6

Iron loss
Inadequate Iron supply
Increased Demand for iron

Question 7

What are some causes of iron deficiency due to iron loss?

Answer 7

Chronic haemorrhage, most commonly through GIT, menstrual.
Phlebotomy: Blood donation, renal dialysis, diagnostic phlebotomy

Question 8

What are the causes of iron deficiency in australia?

Answer 8

Increased need for iron - growth, pregnancy, breastfeeding.
Blood loss due to menstruation or blood donation
Blood loss due to illness or disease, particularly GI bleeding
Inadequate dietary intake of iron
Malabsorption of iron due to intestinal problems, inflammation or surgery.

Question 9

What are the causes of iron deficiency due to inadequate iron supply?

Answer 9

Poor dietary intake
Malabsorption: Gastric and bowel resections, H. Pylori infection, malabsorptive diseases, drug interference (antacid and antisecretory drugs)

Question 10

What are the causes of iron deficiency due to increased demand for iron?

Answer 10

Pregnancy, growth during infancy and childhood, post acute haemorrhage, treatment with ESAs.

Question 11

What would the reason be to prescribe iron tablets every 2nd day rather than every day?

Answer 11

Iron absorption promotes the secretion of hepcidin from the liver. This inhibits iron absorption.

Question 12

What are 5 promoters of iron deficiency?

Answer 12

1. Inflammation / Cancer
2. Failure absorption
3. Iron not recycled
4. Reduced EPO
5. BM failure.

Question 13

How do you minimise blood loss?

Answer 13

Reduced waste
Taking too much blood - 50 mL per day produced, ICU sampling volume can be in excess of 70mL.
Cell Salvage
Tranexamic acid (a lysine binding analogue)
Intra-operative manouvres

Question 14

How to use the third pillar of blood management?

Answer 14

Prescribing single units of blood unless major haemorrhage protocol is needed.