Week 12 Part 1 - Standard 7 and Patient Blood Management Flashcards

1
Q

Blood Stewardship Principles put Forward by Standard 7

A

Informed patient consent
Clinically appropriate blood use
Minimise blood wastage
Adverse event information is collected and managed
Facilities are accredited for quality and safety

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2
Q

Which Products does Standard 7 Cover?

A

All blood components
- packed RBCs
- fresh frozen plasma (FFP)
- platelets
- cryoprecipitate/CP depleted plasma
Plasma derivatives
- albumin
- immunoglobulins
- clotting factors

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3
Q

Three Pillars of Patient Blood Management (PBM)

A

Pillar 1
- optimise RBC mass
Pillar 2
- minimise blood loss
Pillar 3
- manage anaemia

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4
Q

Preoperative Planning

A

Likelihood of surgical blood loss
Likely tolerance of anaemia
Assessment of haemostasis
- family history, platelet count, PT/aPTT
Medications
- anti-platelet/anticoagulant, PPI’s, NSAID’s
Assessment of Hb and iron stores

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5
Q

Intraoperative Considerations - Surgical Techniques that Minimise Blood Loss

A

Controlled hypotension
Patient positioning to minimise venous/arterial pressure
Avoid hypothermia
Topical sealant (thrombin/fibrinogen/aprotinin)

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6
Q

Intraoperative Considerations - Cell Salvage Pros

A

Uses patient’s own fresh RBCs
Volume of available blood is proportional to the amount lost
Reduces exposure to allogeneic blood
Acceptable to most patients who refuse allogeneic blood

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7
Q

Intraoperative Considerations - Cell Salvage Cons

A

Bacterial contamination
Substances used that shouldn’t be infused
Administration of RBCs only

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8
Q

Intraoperative Considerations - Acute Normovolaemic Haemodilution

A

Blood is collected from patient pre-op in OT
Patient is given crystalloid (e.g. saline) or colloid (e.g. albumin) to maintain BV during surgery
Blood is re-infused as needed

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9
Q

Pros of Acute Normovolaemic Haemodilution

A

Number of RBCs lost during surgery is decreased because patient blood is diluted
Reduced risk of adverse transfusion event
Retention of plasma and platelets

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10
Q

Intraoperative Considerations - Use of Systemic Tranexamic Acid (TXA)

A

Lysine analogue that binds to the fibrin binding site of plasminogen
Inhibitor of fibrinolysis = promotes clot formation
Used when significant bleeds are anticipated

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11
Q

Intraoperative Considerations - ROTEM

A

Rotational Thromboelastometry
Used to guide administration of haemostatic agents

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12
Q

ROTEM Tests - EXTEM

A

Activator: TF
Measures: extrinsic pathway

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13
Q

ROTEM Tests - INTEM

A

Activator: ellagic acid
Measures: intrinsic pathway

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14
Q

ROTEM Tests - FIBTEM

A

Activator: TF + cytochalasin D
Measures: fibronogen contribution to clot firmness

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15
Q

ROTEM Tests - APTEM

A

Activator: TF + aprotinin
Measures: effect of fibrinolysis

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16
Q

ROTEM Tests - HEPTEM

A

Activator: ellagic acid + heparinase
Measures: Effect of heparin

17
Q

ROTEM Tests - ECATEM

A

Activator: ecarin
Measures: monitoring of direct thrombin inhibitors

18
Q

ROTEM - Guiding Blood Product Administration: Tranexamic Acid

A

Maximum lysis (ML) > 15% in EXTEM and ↓ MCF on FIBTEM
APTEM is performed, results are compared to EXTEM
TXA given if lysis is observed in EXTEM and inhibited in APTEM

19
Q

ROTEM - Guiding Blood Product Administration: Cryoprecipitate

A

↓ MCF in EXTEM and FIBTEM

20
Q

ROTEM - Guiding Blood Product Administration: Platelets

A

↓ MCF in EXTEM, N MCF in FIBTEM

21
Q

ROTEM - Guiding Blood Product Administration: FFP

A

↑ Clotting time (CT) in EXTEM
If there is an ↑ CT in INTEM, HEPTEM is performed
If HEPTEM CT is ↓, administer protamine
If the HEPTEM CT is ↑, give FFP

22
Q

Intraoperative Considerations - Recombinant Factor VIIa

A

Binds to Tissue Factor → thrombin generation
Only used in life-threatening bleeding NOT controlled by other haemostatic techniques/products
Thrombotic risk

23
Q

Postoperative Considerations

A

Optimise tolerance of anaemia
- prevent hypothermia, hypoxia, infection
- administration of Fe?
Minimise blood loss
- collection tubes
- cell salvage