HaematologyRegistrar [email protected] NHSBT Nurse ... · 75yr old gentleman...
Transcript of HaematologyRegistrar [email protected] NHSBT Nurse ... · 75yr old gentleman...
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1. Who needs a red cell transfusion?
2. How much?
3. Hb trigger
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32yr old lady presents feeling tired. History of menorrhagia.
Hb 69 g/L
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75yr old gentleman Myelodysplastic Syndrome, requires tranfusion every 4-6 weeks.
Feeling tired and feels like he is ready for next tranfusion
Hb 89 g/L
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67yr old lady with chronic kidney disease
Feels tired
Hb 82 g/L
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81yr old gentleman who had a myocardial infarction 2yrs ago
Hb 80 g/L
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65yr old lady awaiting bowel surgery in the four weeks time.
Hb 87 g/L
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80yr old lady on AAU with LRTI & Hb 83 g/ L
Ward round: antibiotics, give 2 units, move on!
What s the Problem?
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Why is she anaemic? Is there an alternative?
Is she symptomatic
Weight of patient ?90kg ?40kg
Is she at risk of fluid overload?
Does she consent?
Special requirementsIrradiationCMV negative
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Its not feeling a bit tired!
Unstable cardiac disease
Orthostatic hypotension
Tachycardia not responding to fluid
Congestive cardiac failure
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Does something need to be replacedIron infusion
Folate/B12
Kidney failureErythropoietin +/- iron
Pre-operativelyIron infusion
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1. Who needs a red cell transfusionSymptomatic anaemia
Alternatives
2. How much?
3. Hb trigger
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If not actively bleeding and haemodynamically stable: Give one and review
Weight is crucial
4 mL/ kg raises Hb by approx 10 g/L
1 unit 10g/L
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1. Who needs a red cell transfusionSymptomatic anaemia
Alternatives
2. How much? Weight of patient
Give one and review
3. Hb trigger
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There is no Universal Trigger!
Should be based on
clinical assessment of the patient
supported by the results of laboratory tests
informed by evidence-based guidelines
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< 80g/ L if haemodynamically stable & non-bleeding
Haemato-oncology patients ok if >80 g/ L and haemodynamically stable
Long term transfusion dependent e.g. MDS No arbitary number use quality of life
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1. Who needs a red cell transfusionSymptomatic anaemia
Alternatives
2. How much? Weight of patient
Give one and review
3. Hb triggerThere is no universal trigger
< 80g/L if haemodynamically stable & non-bleeding
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Previous logic:
They re very sick
Body already under stress
Need to improve tissue oxygenation
Unfortunately it appears to be wrong!
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TRICC (Transfusion Requirements In Critical Care) Liberal group (Trigger Hb <100g/ L)Restrictive group (Trigger Hb <70g/ L)Lower rates of new organ failure in restrictive group & ?lower mortality?more Acute Respiratory Distress Syndrome in liberal group
TRACS (Transfusion Requirements after Cardic Surgery)
FOCUS (Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair)
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1. Who needs a red cell transfusionSymptomatic anaemia
Alternatives
2. How much? Weight of patient
Give one and review
3. Hb triggerThere is no universal trigger
< 80g/ L if haemodynamically stable & non-bleeding
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32yr old lady presents feeling tired. History of menorrhagia.
Hb 69 g/L
![Page 29: HaematologyRegistrar kathrynpullman@gmail.com NHSBT Nurse ... · 75yr old gentleman MyelodysplasticSyndrome, requires tranfusionevery 4-6 weeks. Feeling tired and feels like he is](https://reader033.fdocuments.us/reader033/viewer/2022042321/5f0b73c97e708231d4309684/html5/thumbnails/29.jpg)
75yr old gentleman Myelodysplastic Syndrome, requires tranfusion every 4-6 weeks.
Feeling tired and feels like he is ready for next tranfusion
Hb 89 g/L
![Page 30: HaematologyRegistrar kathrynpullman@gmail.com NHSBT Nurse ... · 75yr old gentleman MyelodysplasticSyndrome, requires tranfusionevery 4-6 weeks. Feeling tired and feels like he is](https://reader033.fdocuments.us/reader033/viewer/2022042321/5f0b73c97e708231d4309684/html5/thumbnails/30.jpg)
67yr old lady with chronic kidney disease
Feels tired
Hb 82 g/L
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81yr old gentleman who had a myocardial infarction 2yrs ago
Hb 80 g/L
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65yr old lady awaiting bowel surgery in the four weeks time.
Hb 87 g/L
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1. Who needs a red cell transfusionSymptomatic anaemia
Alternatives
2. How much? Weight of patient
Give one and review
3. Hb triggerThere is no universal trigger
< 80g/ L if haemodynamically stable & non-bleeding
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1. TRICC study: Critical Care Medicine, 29, 227 234.
2. JPAC: Transfusion Handbook
www.transfusionguidelines.co.ukChapter 6: Alternatives and adjuncts to blood transfusion
Chapter 8: Effective transfusion of medical patients
3. BCSH Guidelines: Red Cells in Critical Care www.bcshguidelines.com