Audit of Platelet Use
|
|
- Abel Barber
- 5 years ago
- Views:
Transcription
1 South West Regional Transfusion Committee Audit of Platelet Use Report by Regional Transfusion Team
2 Acknowledgements Thanks to all transfusion laboratory staff who provided the data for this audit report. Thanks to Sandra Hodgkins who was largely responsible for data entry, and analysis. For information about the report contact: Janet Birchall Maggi Webb Consultant Haematologist Transfusion Laboratory Manager NBS Bristol North Devon Hospital Southmead Rd Raleigh Park Bristol Barnstaple BS10 5ND EX31 4JB Tel: Tel:
3 Contents Page Number Background 1 Aim of Study 1 Method 1 Results 2-9 Discussion 9 10 Summary 11 References 12 Appendices 13
4 Use of Platelets Audit The South West Regional Blood Transfusion Committee Background Although the use of red cells in England has declined steadily since 2000 platelet use has increased. Quarterly platelet issue figures identify that in the South West there has been an increase of 22.5% between April 02 March 05 compared with a 7.5% increase nationally over the same time period. Aim of Study 1. To determine which patients are being transfused platelets. 2. To identify why platelets are being transfused Method To try and achieve maximum participation from Trusts/hospitals in the South West region, the study was kept simple and involved blood bank staff only. An Excel spreadsheet was used for data collection, with each request entered on a separate line. The following data was required: Date of request Demographic details - the age of the patient User details - directorate specialty (see appendix 1) Clinical details - clinical summary (see appendix 2) - whether the platelets were required for prophylaxis or bleeding - the type of operation (if relevant) - the platelet count prior to issue - the number of adult therapeutic doses requested and the number actually given The study period was from 14th November until 11th December 2005, i.e. over a 4- week period. One Trust with a very high platelet use requested that their data collection be limited to a 2-week period, given the significant workload that this would involve. This was agreed and their result was doubled prior to inclusion in the analysis. 1
5 Results Out of 28 Trusts/Hospitals in the South West Region, 22 returned information. 1 Trust confused the data collection period and collected data over the month of November. 2 Trusts provided limited clinical data and one of these failed to provide any data on demographic or user details. All available data from these 3 Trusts was included in the analysis. The number of platelets identified as being requested and used by each Trust was compared with issue data from the National Blood Service over the audit time period. In 1 Trust, the number of platelets identified as used was significantly greater than those issued. On discussion with the main contact, the data supplied was considered inaccurate therefore all data from this Trust was excluded from further analysis. In total data from 21 hospitals was used for this analysis. Using NBS issue data it can be estimated that the audit captured 86% (1323/1535) of all platelets issued. Overall 1323 units of platelets were requested and 1226 units (93%) used for the initial request. Use of Platelets by each Trust/Hospital Table 1 identifies and per Trust/hospital. 4 hospitals requested more than 100 units and 2 of these requested more than 200 units. N.B: If the hospital who recorded usage over a 30-day period in November has been limited to 28-days, their usage would have reduced by 21 units of platelets but their position as the second largest user would not have changed. All 3 private hospitals which provided data used either 1 unit of platelets or none. Table 1 Regional Use of Platelets 300 Number of Platelets A B C D E F G H I J K L M N O P Q R S T U Hospital 2
6 Platelet Use by Age Table 2 identifies the number of platelets used by age category. Both platelets requested and platelets used increase according to age, with the largest number used by patients aged 65 years or above. Table 2 Platelet Use by Age 600 Number of Platelets by age < 16, 16-<40 40-< age UK Age Platelet Use by User (Specialty) Table 3 identifies the number of platelets used by each Specialty - see appendix 1 for list of Specialties. Cardiac surgery, haematology and oncology used more than 100 units of platelets each during the study period. The largest user was haematology, with 779 (59% of total) platelets being requested and 715 (58% of total) used. Oncology requested 149 (11% of total) and used 139 (11% of total). Cardiac surgery requested 111 (8% of total) and used 105 (9% of total). Table 3 Platelet Use by Specialty Number of Platelets Specialty 3
7 Platelet Use by Clinical Summary Table 4 identifies platelets requested / used according to clinical summary. The category associated with the highest use was post chemotherapy followed by bone marrow failure, surgery, bone marrow transplant and MDS. This is compatible with table 2 which identifies the highest specialty use by haematology, oncology and cardiac surgery. Although the highest single category of platelet use by clinical summary was other 165 of these cases, were haematological malignancy where the exact reason for the platelet request was unknown. Table 4 Platelet Use by Clinical Summary Number of Platelets DIC BMT PCX Prophylactic or Therapeutic Use PCX / BMT BMF BMF/MDS BMS MDS MDS / PCX Clinical Summary MDS / SUR NAT SUR OTHER UK When prophylactic or therapeutic use of platelets was known, 75% of all platelets were used for prophylaxis (prophylactic 904, prophylactic 838; therapeutic 310, therapeutic 289) see Table 5. The vast majority of prophylactic use was by haematology (676 and 621 ). Oncology accounted for 128 platelets requested and 118 used. Cardiac surgery was the highest single users of platelets for therapeutic use, with 94 and 92. The second largest user in this category was haematology, with 58 and 51. ITU requested 27 units and used 24 and oncology and general medicine requested and used 20 units of platelets each. 4
8 Table 5 Prophylactic vs Therapeutic Use 1000 Number of Platelets Prophylaxis Bleeding Unknown Use When Prophylactic or Therapeutic use Indicated 25% Prophylaxis Bleeding 75% 25% Prophylaxis Bleeding 75% 5
9 Prophylactic Use by Platelet Count When the platelet count was known 635 units (73%) were requested when the platelet count was measured at more than 10, compared with 235 units (27%) when the platelet count was known to be 10 or less, see Table 6. When the platelet count was more than 10 the main clinical indications were post chemotherapy, other (most use occurred in haematological malignancy), bone marrow failure, bone marrow transplant and MDS - see table 7. Table 6 Prophylactic Use by Platelet Count Number of Platelets Platelets < 10 Platelets > 10 Platelet count UK Platelet Count Prophylactic Use When the Platelet Count was Known 27% Platelets < 10 Platelets > 10 73% 6
10 29% Platelets < 10 Platelets > 10 71% Table 7 Prophylactic Use When Platelet Count >10 Number of Platelets BMF BMF/MDS BMS BMT MDS MDS/SUR MDS/PCS OTHER PCX Clinical Summary PCX/BMT SURGERY NOT KNOWN 7
11 Therapeutic use by Platelet Count 310 units of platelets were requested and 289 used to control bleeding see table 8. When the platelet count was know 150 (53%) were requested when the previously available platelet count was more than 50x10 9 /L. Out of these 70/150 (47%) were requested for cardiac surgery and 56/150 (37%) for other surgical patients. Table 8 Therapeutic Use by Platelet Count Number of Platelets Platelets < 50 Platelets > 50 Unknown Platelet Count Therapeutic Use When the Platelet Count was Known 53% 47% Platelets < 50 Platelets > 50 8
12 53% 47% Platelets < 50 Platelets > 50 Discussion The results of this study are compatible with data collected by the RTC in May 2005 indicating that platelet use per hospital in the South West region is very different but consistent. 4 hospitals requested more than 100 units, and 3 hospitals used more than 100 units over a 4 week period. One hospital which was identified as a large platelet user in May did not contribute data to this audit as their information was identified as unreliable. The high platelet use in patients of 65 years or older is of concern as the age profile of the population is increasing. The vast majority of platelets were used by haematology (58%). Oncology and cardiac surgery were the next highest users, however combined they used around a 1/3rd of those used by haematology. 75% of all platelets were given to prevent bleeding rather than treat bleeding. BCSH Guidelines recommend prophylactic transfusion without additional risk factors at a platelet count of 10x10 9 /L or less. This threshold is based on level 1b evidence (at least one randomised controlled trial). Despite this, 73% of all prophylactic platelets used in this study, where the platelet count was known, were associated with a recorded platelet count of greater than 10x10 9 /L. This could be explained by: a) use in patients with additional risk factors for bleeding such as sepsis, coagulopathy, or before an invasive procedure. Surgery was the clinical summary in 5% of requests when the platelet count was greater than 10 and therefore did not account for significant use in this category. b) use in patients when the count is predicted to fall - the platelet units are short dated or a further hospital attendance for an outpatient would be inconvenient. Use in this category is more likely if the patients platelet count is not routinely available to the transfusion laboratory prior to requesting delivery of blood products from the NBS. c) lack of adherence to BCSH Guidelines. 9
13 BCSH Guidelines recommend transfusion of platelets when bleeding occurs if the patients platelets are dysfunctional or to achieve a count of greater than 50x10 9 /L (higher at around 100x10 9 /L in CNS bleeding or patients with multiple trauma). When the count was known, more than ½ of platelets were given when the last recorded count was higher than 50x10 9 /L. 47% of these were used during cardiac surgery and 37% for other surgical procedures. Dysfunctional platelets, lack of an immediately available platelet count, a desire for a higher threshold platelet count and availability of platelets are likely to be significant factors for requests in this category. The use of near patient testing should be considered when quantitative or qualitative platelet problems are suspected. To further investigate platelet use according to counts, data from the 4 largest users was considered, see table 9. These Trusts/hospitals were chosen for this analysis to reduce bias caused by individual patients. The results illustrate significantly different use - in Trust/hospital F only 49% of all prophylactic platelets were requested when the platelet count was more than 10x10 9 /L compared to 80% in the other 3 Trust/hospitals. In Trust /hospital M a much smaller number of platelets were used when the platelet count was greater than 10x10 9 /L than requested, 21(75%) v 36 (80%). These findings are likely to represent platelet use in categories b) and c) above rather than true differences in the patients risk factors for bleeding between the Trusts/hospitals although verification would require further audit. It is worth noting that Trust /hospital F is close to an NBS centre and therefore platelet supply. Therapeutic use was also different between these users however the data is likely to be less reliable as the numbers in some are small. Table 9: Prophylactic and Therapeutic use by Platelet Count in the 4 largest Trust/hospital users Platelets requested M C F L Req % Req % Req % Req % Proph < Proph > Proph UK Bleed < Bleed > UK Platelets used M C F L Used % Used % Used % Used % Proph < Proph > Proph UK Bleed < Bleed > UK
14 Summary The results of this study indicate that: patients aged 65 years or older use most platelets. The increasing age profile of the population will require platelet collection by the National Blood Service, and the cost to Trusts / hospitals to increase unless platelet use alters. Almost 60% of all platelets are requested and used by haematology. Conservative use by staff in this specialty will have a significant effect on total platelet use and influence use by other specialties. 75% of all platelets are used for prophylaxis and 73% of these at pre-transfusion counts of greater than 10x10 9 /L. - Each Trust / hospital should have guidelines for appropriate platelet transfusion which are widely disseminated and monitored for compliance by regular audit. - Platelet counts, from patients at risk of requiring prophylactic platelet transfusions, should be available prior to the transfusion laboratory requesting delivery from the NBS. - A randomised controlled trial to assess the risks and benefits of not having a threshold platelet count in non haemorrhagic patients is required. More platelets were used to treat bleeding when the last measured count was greater than 50x10 9 /L. - Consideration should be given to the use of near patient testing to assess the need for platelets. - Guidelines for appropriate use should be widely disseminated and monitored for compliance by regular audit. 11
15 References: Benjamin RH & Anderson KC (2002) What is the proper threshold for platelet transfusion in patients with chemotherapy-induced thrombocytopenia? Critical Reviews in Oncology/Hematology, 42, British Committee for Standards in Haematology (BCSH) (2003). Guidelines for the sue of platelet transfusions. British Journal of haematology, 122, Eikenboom JCJ, van Wordragen R & Brand A (2005) Compliance with prophylactic platelet transfusion trigger in haematological patients. Transfusion Medicine, 15, Friedmann AM, Sengul H, Lehmann H, Schwartz C & Goodman S (2002) Do basic laboratory tests or clinical observations predict bleeding in thrombocytopenic oncology patients? Transfusion Medicine Reviews, 16, Stansworth SJ, Hyde C, Heddle N, Rubella P, Brunskill S & Murphy MF (2004) Prophylactic Platelet Transfusion for Haemorrhage after Chemotherapy and Stem Cell Transplantation. John Wiley & Sons, Ltd, Chichester, UK. The Cochrane Database of Systematic Reviews 2004, art No: CD pub2, doi: 10,1002/ CD pub2. 12
16 Appendix 1 Specialty Code Specialty Code General Surgery 1 Vascular Surgery 2 Urology 3 Plastics/burns 4 Cardiac Surgery 5 Neurosurgery 6 Orthopaedics/Trauma 7 ITU 8 A/E 9 SCBU 10 Obstetrics 11 Gynaecology 12 General Medicine 13 Haematology 14 Oncology 15 Renal 16 Cardiology 17 Neurology 18 Rheumatology 19 Care of the Elderly 20 Paediatric Medicine 21 Other (please specify) 22 Appendix 2 Clinical Summary Disseminated Intravascular Coagulation Bone Marrow Transplant Post Chemotherapy Bone marrow failure due to infiltration by disease Bone marrow failure due to sepsis Myelodysplastic syndrome Neonatal alloimmune thrombocytopenia Surgery (please state operation) Other (please specify) DIC BMT PCX BMF BMS MDS NAT SUR Code 13
National Comparative Audit of Blood Transfusion Audit of Red Cell & Platelet Transfusion in Adult Haematology Patients.
National Comparative Audit of Blood Transfusion 2016 Audit of Red Cell & Platelet Transfusion in Adult Haematology Patients South West RTC Why was this audit necessary? Up to 65% of all platelet transfusions
More informationLaboratory Empowerment. Debbie Asher Adrian Ebbs Transfusion Laboratory Managers, Eastern Pathology Alliance
Laboratory Empowerment Debbie Asher Adrian Ebbs Transfusion Laboratory Managers, Eastern Pathology Alliance Why? Electronic ICE requesting was in use for requesting red cells NBTC Indication Codes were
More informationWhen should I transfuse platelets and plasma for children? Dr Liz Chalmers. Consultant Paediatric Haematologist Royal Hospital for Children Glasgow
When should I transfuse platelets and plasma for children? Dr Liz Chalmers Consultant Paediatric Haematologist Royal Hospital for Children Glasgow When should I transfuse platelets and plasma in children?
More information2017 Repeat Audit of Red cell and Platelet Transfusion in Adult Haematology Patients
07 Repeat Audit of Red cell and Platelet Transfusion in Adult Haematology Patients Haematology Audit July 07 The audit was conducted on adults undergoing surgery and who received a transfusion during a
More informationBlood Transfusion Guidelines in Clinical Practice
Blood Transfusion Guidelines in Clinical Practice Salwa Hindawi Director of Blood Transfusion Services Associate Professor in Haematology and Transfusion Medicine King Abdalaziz University, Jeddah Saudi
More informationNational Comparative Audit of Blood Transfusion 2016 Audit of Red Cell & Platelet Transfusion in Adult Haematology Patients National Results
National Comparative Audit of Blood Transfusion National Comparative Audit of Blood Transfusion 2016 Audit of Red Cell & Platelet Transfusion in Adult Haematology Patients National Results 1 Acknowledgements
More informationDr Megan Rowley. CONSULTANT HAEMATOLOGIST - NHSBT and Imperial
Dr Megan Rowley CONSULTANT HAEMATOLOGIST - NHSBT and Imperial Patient Blood Management 2015! Better Blood Transfusion (BBT) HSCs in1998, 2002, 2007 recommended that blood was used safely and appropriately
More informationTitle of Guideline (must include the word Guideline (not protocol, policy, procedure etc)
Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Contact Name and Job Title (author) Guideline on the management of excessive coumarin anticoagulation in adults
More informationManaging Coagulopathy in Intensive Care Setting
Managing Coagulopathy in Intensive Care Setting Dr Rock LEUNG Associate Consultant Division of Haematology, Department of Pathology & Clinical Biochemistry Queen Mary Hospital Normal Haemostasis Primary
More informationCAUTION: Refer to the Document Library for the most recent version of this document. Cryoprecipitate Transfusion Guideline for Practice.
Directorate Department Year Version Number Central Index Number Endorsing Committee Date Endorsed Approval Committee Date Approved Author Name and Job Title Key Words (for search purposes) Date Published
More informationTitle Patients receiving dabigatran requiring emergency reversal for surgery or treatment of haemorrhage Guidelines. Department.
Document Control Title Patients receiving dabigatran requiring emergency reversal for surgery or treatment of haemorrhage Guidelines Author Author s job title Pharmacist Directorate PCS - Department Version
More informationTRANSFUSION GUIDELINES FOR CARDIOTHORACIC UNIT 2006
TRANSFUSION GUIDELINES FOR CARDIOTHORACIC UNIT 2006 CTU blood product transfusion guidelines 2006 1 Summary of guidelines RED CELLS (10-15ml/kg) This applies to ward patients / icu patients who are stable.
More informationIdiopathic Thrombocytopenic Purpura
Idiopathic Thrombocytopenic Purpura Title of Guideline Contact Name and Job Title (author) Directorate & Speciality Guideline for the management of idiopathic thrombocytopenic purpura Dr S Stokley, Consultant
More informationBBTS Who really needs a transfusion?
BBTS Who really needs a transfusion? Simon J Stanworth Consultant Haematologist National Health Service Blood & Transplant/ Oxford University Hospitals NHS Trust; University of Oxford Conflicts no financial,
More informationAppendix 3 PCC Warfarin Reversal
Appendix 3 PCC Warfarin Reversal Reversal of Warfarin and Analogues 1. Principle of Procedure Guidelines for the Reversal of Oral-anticoagulation in the Event of Life Threatening Haemorrhage Prothrombin
More informationAudit of Blood Use in Orthopaedic Surgery. Comparative Report
West Midlands Regional Transfusion Committee Audit of Blood Use in Orthopaedic Surgery Comparative Report West Midlands RTC Audit Group Dr Craig Taylor (Chair), Andrea Blest, Dr Matthew Lumley, Jenny Hartley,
More informationLoPAG Platelets in London. Rachel Moss May 2013
LoPAG Platelets in London Rachel Moss May 2013 Platelets in London are harder to get than a table at The Ivy! In the beginning we had graphs and the Blood Stocks Management Scheme data Platelet issues
More informationGuidelines for the Management of Platelet Transfusion Refractoriness GUIDELINES FOR THE MANAGEMENT OF PLATELET TRANSFUSION REFRACTORINESS
GUIDELINES FOR THE MANAGEMENT OF PLATELET TRANSFUSION REFRACTORINESS Reviewed by Dr Colin Brown (26/03/2008) Author(s): Colin Brown Page 1 of 7 Purposes To define and recommend policies and procedures
More informationBlood is serious business
Transfusion at RCH BLOOD TRANSFUSION Anthea Greenway Dept of Clinical Haematology >10000 fresh blood products per year Supports craniofacial and cardiac surgery Support bone marrow, liver transplant and
More informationCrossmatching and Issuing Blood Components; Indications and Effects.
Crossmatching and Issuing Blood Components; Indications and Effects. Alison Muir Blood Transfusion, Blood Sciences, Newcastle Trust Topics Covered Taking the blood sample ABO Group Antibody Screening Compatibility
More informationGuideline for platelet transfusion thresholds for pediatric hematology/oncology patients. Khoa Ung bướu - Huyết học
Guideline for platelet transfusion thresholds for pediatric hematology/oncology patients Khoa Ung bướu - Huyết học Reference Sources: C17 Council (Canada) Guideline release date: June, 2010; Literature
More informationAdministration of blood components. Tina Parker - Transfusion Practitioner
. Administration of blood components Tina Parker - Transfusion Practitioner Red Cells Each unit contains 250-350mls Preserved with glucose and Mannitol to keep the correct tension Lasts 35 days from midnight
More informationLong-stay patients methodology Published by NHS England and NHS Improvement
Long-stay patients methodology Published by NHS England and NHS Improvement July 2018 1 Document Title: Long-stay patients methodology Version number: 1.0 First published: 9 July 2018 Updated: Prepared
More informationHaematology and Haematological Oncology
Haematology and Haematological Oncology Updated on 23 Feb 2017 I) OBJECTIVES 1. To provide a broad training and in-depth experience at a level sufficient for trainees to acquire competence and professionalism
More informationManagement of haemorrhage in patients taking DOACs/ NOACs (direct/ novel oral anticoagulants) Guideline. Contents
Management of haemorrhage in patients taking DOACs/ NOACs (direct/ novel oral anticoagulants) Guideline Classification: Clinical Guideline Lead Author: Dr Rowena Thomas-Dewing, Consultant Haematologist
More informationBrief Audit of Platelet Use in the Yorkshire and The Humber Region
Brief Audit of Platelet Use in the Yorkshire and The Humber Region Anne Davidson, Patient Blood Management Practitioner, Yorkshire and The Humber Regional Transfusion Committee Introduction This project
More informationPREDICT: PREdic-ng bleeding In cri-cally ill Children with Thrombocytopenia. Marianne Nellis, MD, MS 3/11/15 BloodNet
PREDICT: PREdic-ng bleeding In cri-cally ill Children with Thrombocytopenia Marianne Nellis, MD, MS man9026@med.cornell.edu 3/11/15 BloodNet Conflicts of Interest Disclosure I have no financial rela-onships
More informationApproach to disseminated intravascular coagulation
Approach to disseminated intravascular coagulation Khaire Ananta Shankarrao 1, Anil Burley 2, Deshmukh 3 1.MD Scholar, [kayachikitsa] 2.Professor,MD kayachikitsa. 3.Professor and HOD,Kayachikitsa. CSMSS
More informationBlood transfusion. Dr. J. Potgieter Dept. of Haematology NHLS - TAD
Blood transfusion Dr. J. Potgieter Dept. of Haematology NHLS - TAD General Blood is collected from volunteer donors >90% is separated into individual components and plasma Donors should be: healthy, have
More informationAn Audit of Emergency Group O blood use in Royal Devon and Exeter Hospital
An Audit of Emergency Group O blood use in Royal Devon and Exeter Hospital Jack Cunningham Keira Soanes Why are we looking at our use of Emergency Group O RhD negative blood? Following the NHSBT National
More informationSTATISTICAL PRESS NOTICE NHS REFERRAL TO TREATMENT (RTT) WAITING TIMES DATA JANUARY 2013
STATISTICAL PRESS NOTICE NHS REFERRAL TO TREATMENT (RTT) WAITING TIMES DATA JANUARY 2013 Data are published on consultant-led Referral to Treatment (RTT) waiting times for patients who were treated during
More informationNICE guideline Published: 18 November 2015 nice.org.uk/guidance/ng24
Blood transfusion NICE guideline Published: 18 November 2015 nice.org.uk/guidance/ng24 NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationCoagulation, Haemostasis and interpretation of Coagulation tests
Coagulation, Haemostasis and interpretation of Coagulation tests Learning Outcomes Indicate the normal ranges for routine clotting screen and explain what each measurement means Recognise how to detect
More informationManagement of Anaemia reduces Red cell Transfusion in NI. Dr Susan Atkinson NI Transfusion Committee
Management of Anaemia reduces Red cell Transfusion in NI Dr Susan Atkinson NI Transfusion Committee BBTS September 2014 Patient and Client Council Department of Health Chief Medical Officer Expert Professionals
More informationTitle Protocol for the management of suspected cauda equine syndrome & decompensating spinal stenosis at NDDH
Document Control Title Protocol for the management of suspected cauda equine syndrome & decompensating spinal stenosis at NDDH Author Author s job title Consultant T&O Directorate Scheduled Care Department
More informationMajor Haemorrhage Protocol. Commentary
Hairmyres Hospital Monklands Hospital Wishaw General Hospital Major Haemorrhage Protocol Commentary N.B. There is a separate NHSL protocol for the Management of Obstetric Haemorrhage Authors Dr Tracey
More informationHOSPITAL MEDICINE BECOMING A PHYSICIAN
HOSPITAL MEDICINE BECOMING A PHYSICIAN DR MIKE MASDING Consultant Physician & Diabetologist Poole Hospital NHS Foundation Trust 24 September 2010 Hospital Medicine Becoming a Physician What is a Physician?
More informationAn Approach to the Patient Refractory to Platelets Transfusion. Harold Alvarez, MD
Harold Alvarez, MD Objectives Explain the etiology of platelet refractoriness Discuss the different types of platelet refractoriness Describe how platelet refractoriness is diagnosed Discuss different
More informationJuly 27 th - 31 st Provisional Programme. Monday DiLo Cardiologist DiLo Cardiothoracic Surgeon DiLo Acute Physician
Provisional Programme Monday Group A - Medicine Group B - Group C - Acute / Specialist 0800-0845 Registration 0845-0930 Welcome & Introduction 0930-1030 DiLo Cardiologist DiLo Cardiothoracic Surgeon DiLo
More informationSingle unit transfusion audit PE Smith B Ferguson
Single unit transfusion audit PE Smith B Ferguson Brief introduction Method: A retrospective audit performed in November 2015 Standards: All stable, normovolaemic adult inpatients who require transfusion
More informationNorth East Essex Medicines Management Committee
Colchester Hospital University NHS Foundation Trust North East Essex Clinical Commissioning Group North East Essex Medicines Management Committee ORAL ANTICOAGULANT (Vit K antagonist only) MANAGEMENT GUIDELINES
More informationBLOOD COMPONENT SUPPORT OF RhD NEGATIVE INDIVIDUALS
REASON FOR ISSUE: Review of section 4 along with changes in requirement to inform TMS in respect of authorisation process (in Appendix A) DCR16969. 1. INTRODUCTION of RhD positive blood components to an
More informationWORKING TOGETHER FOR THE NHS 20/07/2018
20/07/2018 NHS Improvement and NHS England Wellington House 133-155 Waterloo Road London SE1 8UG 020 3747 0000 www.england.nhs.uk www.improvement.nhs.uk To: Regional Directors, Trust Medical Directors,
More information2017 ST3 Competition Ratios Medical Specialties
2017 ST3 Competition Ratios Medical Specialties Applications Received Posts Available Competition Ratio Acute Internal Medicine 245 125 1.96 Allergy 8 3 2.67 Audiovestibular Medicine 9 1 9 Cardiology 361
More informationPage 1 of 6. Low 1 (score 0-3) Monitor platelets and signs and symptoms of thrombosis and continue heparin
Page 1 of 6 Estimate probability of HIT using the Four T s 1 Low 1 (score 0-3) Intermediate 1 (score 4-5) or High 1 (score 6-8) Monitor platelets and signs and symptoms of thrombosis and continue heparin
More informationOnline Supplementary Data. Country Number of centers Number of patients randomized
A Randomized, Double-Blind, -Controlled, Phase-2B Study to Evaluate the Safety and Efficacy of Recombinant Human Soluble Thrombomodulin, ART-123, in Patients with Sepsis and Suspected Disseminated Intravascular
More informationEstcourt LJ, Stanworth SJ, Doree C, Hopewell S, Trivella M, Murphy MF
Comparison of different platelet count thresholds to guide administration of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy
More informationContents SECTION 1: PHYSIOLOGY OF BLOOD
Contents SECTION 1: PHYSIOLOGY OF BLOOD Chapter 1: Overview of Physiology of Blood 1 Normal Haematopoiesis 1 Red Blood Cells 6 White Blood Cells 15 Immune System 27 Megakaryopoiesis 32 Normal Haemostasis
More informationNorth West Regional Transfusion Committee Audit of Platelet Use and Wastage
North West Regional Transfusion Committee Audit of Platelet Use and Wastage Facts & Figures demand and wastage Demand increased by 13% over the past three years North West demand in March 2014 is up 3.2%
More informationNewcastle upon Tyne Blood Transfusion Course
Newcastle upon Tyne Blood Transfusion Course Susan Whitehead Transfusion Practitioner (Recently Retired and loving it) Newcastle Did we need a Course? Came into post May 2000 Back ground General Surgery/Day
More informationMost Common Hemostasis Consults: Thrombocytopenia
Most Common Hemostasis Consults: Thrombocytopenia Cindy Neunert, MS MSCS Assistant Professor, Pediatrics CUMC Columbia University TSHNA Meeting, April 15, 2016 Financial Disclosures No relevant financial
More informationHigh Intensity Chemotherapy Guidelines for Haematology Patients at ASPH
High Intensity Chemotherapy Guidelines for Haematology Patients at ASPH Contents: Page No. 1. Overview 2 2. Admission 3 3. Admission Checklist 5 4. Inpatient management during chemotherapy 6 5. Inpatient
More informationSurvey of Massive Blood Loss In the North East of England 2013
Survey of Massive Blood Loss In the North East of England 2013 November 2014 Acknowledgements Dr Michelle Lannon ST6 Haematology The Newcastle upon Tyne Hospitals NHS Foundation Trust Dr Adil Iqbal Consultant
More informationGuideline for the Use of Granulocyte Colony Stimulating Factor (G-CSF) for Adults in Oncology and Haematology
(G-CSF) for Adults in Oncology and Haematology For Use in: By: Oncology and Haematology Inpatients and Outpatients Oncologists and Haematologists For: Division responsible for document: Key words: Name
More informationMASSIVE TRANSFUSION DR.K.HITESH KUMAR FINAL YEAR PG DEPT. OF TRANSFUSION MEDICINE
MASSIVE TRANSFUSION DR.K.HITESH KUMAR FINAL YEAR PG DEPT. OF TRANSFUSION MEDICINE CONTENTS Definition Indications Transfusion trigger Massive transfusion protocol Complications DEFINITION Massive transfusion:
More informationOur business is improving the quality of primary care and creating opportunity for primary care to develop its services.
BICS Our Business Our business is improving the quality of primary care and creating opportunity for primary care to develop its services. Quality of experience care designed around individuals and subpopulations.
More informationPaediatric Transfusion Guidelines
Paediatric Transfusion Guidelines Tiny Transfusions Yorkshire and Humbar RTC meeting Helen New Consultant in Paediatric Haematology and Transfusion Medicine Imperial College NHS Trust/ NHSBT BCSH www.bcshguidelines.com
More informationIschemic Stroke in Critically Ill Patients with Malignancy
Ischemic Stroke in Critically Ill Patients with Malignancy Jeong-Am Ryu 1, Oh Young Bang 2, Daesang Lee 1, Jinkyeong Park 1, Jeong Hoon Yang 1, Gee Young Suh 1, Joongbum Cho 1, Chi Ryang Chung 1, Chi-Min
More informationGB13/168a. Consultant to Consultant Referral Policy
GB13/168a Consultant to Consultant Referral Policy 1 Reader information Reference Directorate Document purpose Clinical Contracting To detail the policy of the organisation in terms Consultant to Consultant
More informationBlood Components & Indications for Transfusion. Neda Kalhor
Blood Components & Indications for Transfusion Neda Kalhor Blood products Cellular Components: Red blood cells - Leukocyte-reduced RBCs - Washed RBCs - Irradiated RBCs Platelets - Random-donor platelets
More informationLahey Clinic Internal Medicine Residency Program: Curriculum for Hematology
Lahey Clinic Internal Medicine Residency Program: Curriculum for Hematology Faculty representative: Neil Weiner, MD Resident representative: Guiherme Rabinowits, MD Revision date: February 28, 2006 Goals
More informationCareers in Haematology
Careers in Haematology A guide for medical students and junior doctors About haematology: Haematology is the medical speciality concerned with blood disorders. Your non-medical friends however will always
More information2016 Re-Audit of Patient Blood Management in adults undergoing elective, scheduled surgery
2016 Re-Audit of Patient Blood Management in adults undergoing elective, scheduled surgery 2017 Re-Audit of Red Cell & Platelet Transfusion in Adult Haematology patients South West RTC 2016 Re-Audit of
More informationReference No: SG 23/13
Title: Author(s) Ownership: Approval by: Guidelines for the use of granulocyte colony stimulating factor (GSCF) in adult oncology & malignant haematology patients Paula Scullin, Consultant Medical Oncologist,
More information2 Diagnosis and Staging of Cancer 2.1 Pathophysiology of cancer 2.2 Classification and staging 2.3 Diagnostic measures for specific cancer types
Oncology Nursing Sub-Specialty Module Reference: Gobel B. M., Triest-Robertson S. & Vogel W.H. (Eds). (205). Advanced Oncology Nursing Certificate Review and Resources Manual. Pittsburgh: Oncology Nursing
More informationDeveloped for Scotland by the National Plasma Product Expert Advisory Group. Clinical Guidelines for Human Albumin Use
Approved by NPPEAG 28 May 2018 Reviewed 1 June 2018 To be reviewed 1 June 2020 Developed for Scotland by the National Plasma Product Expert Advisory Group Clinical Guidelines for Human Albumin Use 1 National
More informationBCSH Appropriate Use of O Neg. Dr Megan Rowley Consultant In Transfusion Medicine SNBTS at the Royal Infirmary of Edinburgh
BCSH Appropriate Use of O Neg Dr Megan Rowley Consultant In Transfusion Medicine SNBTS at the Royal Infirmary of Edinburgh http://www.b-sh.org.uk/guidelines/ Good Practice Paper Used to recommend good
More informationJuly 3, The Physician Compare Team Centers for Medicare and Medicaid Services 7500 Security Boulevard Baltimore, MD 21244
July 3, 2013 The Physician Compare Team Centers for Medicare and Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 Re: Physician Compare Intelligent Search To Whom it May Concern, The American
More information2015 Detailed Postgraduate Training Report: Grampian
2015 Detailed Training Report: Grampian out of hours Aberdeen Maternity Hospital - N161H Community Sexual and Reproductive Health ST 1 Aberdeen Maternity Hospital - N161H Obstetrics and Gynaecology F2
More informationDr Marina Karakantza Consultant Haematologist, NHSBT
Dr Marina Karakantza Consultant Haematologist, NHSBT Overview Definition of transfusion thresholds Mechanisms of adaptation to anaemia How RBC transfusion affect adaptation mechanisms to anaemia Triggers
More informationLeeds Children s Hospital Aiming high, delivering the best
Leeds Children s Hospital Aiming high, delivering the best we were in expert hands Leeds Children s Hospital is one of the leading hospitals for children and young people in the United Kingdom, with a
More informationTrust Board Meeting in Public: Wednesday 11 July 2018 TB
Trust Board Meeting in Public: Wednesday 11 July 2018 Title Integrated Performance Report: Month 2 Status History For information. The report provides a summary of the Trust s performance against a range
More informationTransplants. Mickey B. C. Koh
Transfusion in Stem Cell Transplants Mickey B. C. Koh Director: Stem Cell Transplant Programme Department of Haematology, St. George s Hospital and Medical School, London, UK Medical Director: Cell Therapy
More informationGuidelines for Gamma Irradiation of Blood Components
AUSTRALIAN & NEW ZEALAND SOCIETY OF BLOOD TRANSFUSION INC. AUSTRALIAN RED CROSS BLOOD SERVICE NEW ZEALAND BLOOD SERVICE Guidelines for Gamma Irradiation of Blood Components Revised 2003 AN ZS B T Australian
More informationBlood Component Therapy
Blood Component Therapy Dr Anupam Chhabra Incharge-Transfusion Medicine Pushpanjali Crosslay Hopital NCR-Delhi Introduction Blood a blood components are considered drugs because of their use in treating
More informationLifeBridge Health Transfusion Service Sinai Hospital of Baltimore Northwest Hospital Center BQA Transfusion Criteria Version#2 POLICY NO.
LifeBridge Health Transfusion Service Sinai Hospital of Baltimore Northwest Hospital Center BQA 1011.02 Transfusion Criteria Version#2 Department POLICY NO. PAGE NO. Blood Bank Quality Assurance Manual
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Abdomen, acute, in oncological surgery patients, critical care issues in, 101 102 Acquired factor VIII inhibitors, in critically ill cancer
More informationPAEDIATRIC Point Prevalence Survey. Ward Form
Appendix 1 PAEDIATRIC Point Prevalence Survey Ward Form Please fill in one form for each ward included in PPS Date of survey Person completing form (Auditor code) Hospital Name Department/Ward Paediatric
More informationCHEMOTHERAPY NETWORK GROUP POLICY FOR ADMINISTRATION OF CYTOTOXIC CHEMOTHERAPY
CHEMOTHERAPY NETWORK GROUP POLICY FOR ADMINISTRATION OF CYTOTOXIC CHEMOTHERAPY Version 4.0 March 2016 Review date March 2018 Introduction It is the purpose of this policy to provide clear guidelines that
More informationMedical Training Initiative Post Paediatric Oncology Fellow Retrieval. Job Description Lead Clinician Dr Emma Ross
Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust Medical Training Initiative Post Paediatric Oncology Fellow Retrieval. Job Description Lead Clinician Dr Emma Ross 2018 Hospital:
More informationTransfusion Triggers. Richard Soutar January 2012
Transfusion Triggers Richard Soutar January 2012 1 Educational objectives: To understand the risks of transfusion - the known, the uncertain and unknown To understand the fear of the unknown in Transfusion
More informationBlood & Marrow Transplant Leukemia Immunotherapy
Blood & Marrow Transplant Leukemia Immunotherapy Our Physicians Our specially trained physicians provide leadership for the Northside Hospital Blood and Marrow Transplant, Leukemia and Immunotherapy Programs,
More informationThe C 17 Standards and Guidelines Committee Guideline for Platelet Transfusion Thresholds for Pediatric Oncology Patients. Quick Reference Guide
The C 17 Standards and Guidelines Committee Guideline for Platelet Transfusion Thresholds for Pediatric Oncology Patients Quick Reference Guide Preamble Note C 17 supportive care guidelines are developed
More informationCRITERIA FOR CREDENTIALLING A PAEDIATRIC HAEMATOLOGIST- ONCOLOGIST IN THE MALAYSIAN SPECIALIST REGISTER
Page 10f8 REVISED (29-8-09) CRITERIA FOR CREDENTIALLING A PAEDIATRIC HAEMATOLOGIST- ONCOLOGIST IN THE MALAYSIAN SPECIALIST REGISTER The criteria are as follows: 1. A basic medical degree recognised by
More informationA National Model of Care for Paediatric Healthcare Services in Ireland Chapter 36: Non-malignant Haematology
A National Model of Care for Paediatric Healthcare Services in Ireland Chapter 36: Non-malignant Haematology Clinical Strategy and Programmes Division Table of Contents 36.0 Introduction 2 36.1 Current
More informationThe National Cancer Dataset Initiative ddd CTYA SSCRG. Di Riley Associate Director for Clinical Outcomes
The National Cancer Dataset Initiative ddd CTYA SSCRG Di Riley Associate Director for Clinical Outcomes CRS, December 2007...Better information on cancer services and outcomes will enhance patient choice,
More informationGreat Ormond Street Hospital for Children. Patient Transfer. Penny Eyton-Jones TLM, Great Ormond Street NHS Foundation Trust
Patient Transfer TLM, NHS Foundation Trust Patient Transfer - intro Hospital was founded in 1852 by Charles West as the first hospital dedicated to the treatment of children. The original 10 bed hospital
More informationThe Bleeding Jehovah s Witness: A Nightmare Scenario?
The Bleeding Jehovah s Witness: A Nightmare Scenario? David Smith, Bristol Hospital Liaison Committee for Jehovah s Witnesses SW RTC: Bleeding in the Medical Patient - 21 February 2018 Jehovah s Witnesses
More informationPREOPERATIVE PATIENT PREPARATION PROTOCOL
PREOPERATIVE PATIENT PREPARATION PROTOCOL Each surgical discipline should have a standard set of published guidelines for the preparation of its patients for theatre procedures. These should be readily
More informationInternational Journal of Health Sciences and Research ISSN:
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Appropriate and Inappropriate Use of Fresh Frozen Plasma (FFP) and Packed Cell Volume (PCV)
More informationThe importance of thrombocytopenia and its causes
SYSMEX EDUCATIONAL ENHANCEMENT AND DEVELOPMENT NO 4 2017 SEED HAEMATOLOGY The importance of thrombocytopenia and its causes Key words: Thrombocytopenia, thrombocytopenic, low levels of platelets What is
More informationRTT Exception Report
Appendix 3 RTT Exception Report 1. Purpose To provide a summary of factors impacting on 18 week RTT performance and a revised forecast of red rated performance for Quarter 2 2015/16 for the admitted pathway.
More informationStatistical Press Notice NHS referral to treatment (RTT) waiting times data August 2017
Thursday 12 October 2017 Statistical Press Notice NHS referral to treatment (RTT) waiting times data August 2017 NHS England released statistics today on referral to treatment (RTT) waiting times for consultant-led
More informationGreen Amber Red Assurance Level
A re-audit of the turnaround time of samples for the Sickle Cell and Thalassaemia Newborn Screening Programme, in the Manchester Newborn Screening Laboratory Clinical Audit Report May 2014 Clinical Audit
More informationCLINICAL GUIDELINE FOR THE ADMINISTRATION OF MESNA WITH IFOSFAMIDE AND CYCLOPHOSPHAMIDE Summary.
CLINICAL GUIDELINE FOR THE ADMINISTRATION OF MESNA WITH IFOSFAMIDE AND CYCLOPHOSPHAMIDE Summary. Yes Is patient prescribed ifosfamide or cyclophosphamide >1g/m 2? Chemotherapy prescription on Aria should
More informationGuidelines for the Management of Chronic Lymphocytic Leukaemia (CLL)
Guidelines for the Management of Chronic Lymphocytic Leukaemia (CLL) Version History Version Date Summary of Change/Process 2.0 08.05.08 Endorsed by the Governance Committee 2.1 16.02.11 Circulated at
More informationApplication Deadlines
Anaesthesia PGME Application Deadline Department Website Anaesthesia Fellowships http://www.anesthesia.utoronto.ca/fellowships offered Adult Critical Care PGME Application Deadline Department Website Critical
More informationHematologic Malignancies 2013 Retrospective Study at Truman Medical Center
Hematologic Malignancies 2013 Retrospective Study at Truman Medical Center Kristen Strasser, MD & Abdulraheem Qasem, MD Introduction: Hematologic Malignancies includes malignant diseases of the bone marrow
More informationSubdural hemorrhages in acute lymphoblastic leukemia: case report and literature review
Yin et al. Chinese Neurosurgical Journal (2016) 2:25 DOI 10.1186/s41016-016-0045-4 CHINESE NEUROSURGICAL SOCIETY CASE REPORT CHINESE MEDICAL ASSOCIATION Subdural hemorrhages in acute lymphoblastic leukemia:
More informationNational Comparative Audit of Blood Transfusion
National Comparative Audit of Blood Transfusion National Comparative Audit of Blood Transfusion 2017 Transfusion Associated Circulatory Overload Audit 0 1 Acknowledgements We wish to thank all those who
More information