The Bleeding Jehovah s Witness: A Nightmare Scenario?

Size: px
Start display at page:

Download "The Bleeding Jehovah s Witness: A Nightmare Scenario?"

Transcription

1 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

2 Jehovah s Witnesses ~ Putting them in context Circa 1:300 of your patients

3 Why Witnesses decline blood The Scriptures (Acts 15): Abstain from... blood... If you keep free from these things you will be doing right. RCS Caring for Patients who Refuse Blood (2016): JWs appreciate high-quality care. They value life and want to do whatever is reasonable and compatible with their beliefs to prolong it.

4 NO 1. Whole Blood 2.RBCs 3. Platelets 4. Plasma (FFP, Octaplas, Lyoplas) 5. WBCs 6. PAD Check 1. Autologous procedures eg Cell Salvage 2. Fractions eg Fibrinogen and other factor concentrates, Albumin, PCC, Cryoprecipitate 3. Transplants No other limitations. Key modalities include: Antifibrinolytics Meticulous Haemostasis Oral & IV Iron Non-blood haemostats, eg Celox Minimal sampling ESAs YES Recombinants

5 Communicating Choices: Key Documents & Wristband 3/19/2018

6 460 and 461 patients in the two groups Hb levels at admission: 95g/L No Transfusion 6 week survival Re Bleeding Adverse Events 45 day Mortality 90g/L trigger 15% 91% 16% 48% 9% 70g/L trigger 51% 95% 10% 40% 5%

7 OVERVIEW FOR THE BLEEDING JW MEDICAL PATIENT No unique procedures or medications so speed and a multimodal approach are crucial 1. Address anaemia even if moderate 2. Identify source of bleeding 3. Treat bleeding & clotting disorders 4. Lower than normal threshold for surgery 1. IV Vit K for severe bleeding 2. Prompt TXA 3. Early or pre-emptive ESAs & iron 4. All surgical & anaesthetic techniques 5. Interventional radiology

8 How to proceed: UGIB Care Pathway at UHB 3/19/2018

9 JW with Severe Anaemia: Hb < 70g/L Initiate Anaemia Protocol: EPO: 40k units daily until Hb > 70 g/l, then 40k units weekly. Iron: 100mg IV iron daily for10 days minimum and then consider conversion to oral. Vitamin C, Folate & Vitamin B12 For multiple scenarios including burn injury, GI haemorrhage, trauma, chemotherapy and THA: A multimodal approach is required. enhance endogenous erythropoiesis, reduce blood loss, increase oxygen delivery and reduce oxygen consumption, and avoid hemodilution and iatrogenic anemia. Monitor Hb etc daily with blood gas (0.3ml) Control bleeding; correct coagulopathy Reduce oxygen consumption Supplemental oxygen Avoid haemodilution How do we treat life-threatening anemia in a Jehovah s Witness patient? Posluszny and Napolitano Transfusion 2014;54:

10 OPERATIVE TECHNIQUES TO MINIMISE BLOOD LOSS Caring for Patients who Refuse Blood, RCS 2016 Techniques to minimize blood loss Anaesthetic Autologous Coagulation stimulants Haemostatic aids Laparoscopic instead of open surgery; interventional radiology; staged procedures; vasoconstrictors, tourniquet & clamps to stem blood flow Controlled hypotension; regional anaesthesia Cell salvage*; ANH* Tranexamic Acid; Recombinant clotting factors VIIa*, VIII, IX; Desmopressin Diathermy; harmonic scalpels; radiofrequency ablation

11 GI Bleed Treatment Options INTRAVENOUS IRON: TATM 12 (2012) INTERVENTIONAL RADIOLOGY: WJ RADIOL 6 (2014) 4:82 Interventional radiology becomes vital in patients whose GIB remains resistant to medical and endoscopic treatment. Radiology offers diagnostic imaging studies and endovascular therapeutic interventions that can be performed promptly and effectively with successful outcomes.

12 Acute upper gastrointestinal bleeding in over 16s NICE Clinical guideline [CG141] Published date: June 2012 Last updated: August 2016 o (Introduction) Acute upper gastrointestinal bleeding has a 10% hospital mortality rate. Elderly patients and people with chronic medical diseases have a higher risk of death. o Base decisions on blood transfusion on the full clinical picture, recognising that over-transfusion may be as damaging as under-transfusion. o Do not use factor Vlla except when all other methods have failed. o (Key Priority) Offer interventional radiology to unstable patients who re-bleed after endoscopic treatment. o Offer endoscopic injection of N-butyl-2-cyanoacrylate to patients with UGI bleeding from gastric varices.

13 Intensive Care Recommendations from Caring for Patients who Refuse Blood, RCS 2016 [E3] 1. Monitor and minimise postop blood loss 2. Monitor and avoid sepsis. 3. Minimise number/volume of blood samples (can be >70ml/day in ICU AJCC, 2013) 4. Ensure staff are aware of the refusal of blood to ensure extra monitoring. 5. Consider postoperative EPO and/or Iron/B Consider postop blood salvage from drains.

14 Multi-Modal Management: Hepatic Bleed in 75 year old o 2am admission to A&E with major bleed from hepatic artery - Hb 55g/L. o TXA, Darbepoetin & IV Iron administered per Trust Policy for JWs. o Open repair would likely have increased blood loss and risk of mortality hence case referred for interventional radiology o TAE (Transcatheter Arterial Embolization) carried out at 7am bleeding arrested o 2pm: No hepatic artery bleeding: Hb > 70g/L o Patient discharged day 3 with Hb > 100g/L

15 o More open to having earlier discussions to allow our patients a better say and understanding about their end-of-life wishes o The majority of doctors would not like their lives prolonged if the likely risks and burdens of treatment would outweigh the expected benefits. 3/19/2018

16 How Far for JWs?? We do not believe that extraordinary, complicated, distressing or costly measures must be taken to sustain a dying person. The consensus may be that those measures would merely prolong the dying process and/or leave the patient with no meaningful life. JWs: Our Views on Healthcare, 2017

17 In Conclusion: What s Different for Jehovah s Witnesses? o No Blood = firm expectation not simply nice if possible. o Prompt & clear identification of what is acceptable for each patient is vital and must be communicated at handovers. o Clinical toolkit is almost always standard PBM, but often will need to be applied earlier, more aggressively and with multidisciplinary input. o Impact is attritional. o Witnesses (have) driven many workers to find alternative strategies for avoiding bleeding and treating it. These have proved successful, and are now not limited to Jehovah s Witnesses, for which wider society owes them a debt of gratitude. Prof Martin Elliott, GOSH; Gresham lecture 2017

18 And finally. 3/19/2018

Blood Conservation. To introduce the learner to the basic concepts of blood conservation!! Learning Outcomes

Blood Conservation. To introduce the learner to the basic concepts of blood conservation!! Learning Outcomes Section 4 Blood Conservation Aim To introduce the learner to the basic concepts of blood conservation Learning Outcomes Identify the principles of blood conservation Identify the areas where blood conservation

More information

Non-Medical Authorisation Course TRANSFUSION ALTERNATIVES. East Midlands Regional Transfusion Committee

Non-Medical Authorisation Course TRANSFUSION ALTERNATIVES. East Midlands Regional Transfusion Committee Non-Medical Authorisation Course TRANSFUSION ALTERNATIVES Janice Smith Matron Transfusion Specialist (Slides Leanne Hostler & Ant Jackson!) Aims Why we need to consider alternatives? What alternatives

More information

Transfusion Requirements and Management in Trauma RACHEL JACK

Transfusion Requirements and Management in Trauma RACHEL JACK Transfusion Requirements and Management in Trauma RACHEL JACK Overview Haemostatic resuscitation Massive Transfusion Protocol Overview of NBA research guidelines Haemostatic resuscitation Permissive hypotension

More information

Patient Blood Management. vs. Dr. Petro-Lize Wessels PBM Consultant SANBS August 2018

Patient Blood Management. vs. Dr. Petro-Lize Wessels PBM Consultant SANBS August 2018 Patient Blood Management vs. Dr. Petro-Lize Wessels PBM Consultant SANBS August 2018 Overview Definition 3 Predictors of negative clinical outcomes 3 Pillars of patient blood management What is my role?

More information

A Guide To Safe Blood Transfusion Practice

A Guide To Safe Blood Transfusion Practice A Guide To Safe Blood Transfusion Practice Marie Browett, Pavlina Sharp, Fiona Waller, Hafiz Qureshi, Malcolm Chambers (on behalf of the UHL Blood Transfusion Team) A Guide To Safe Blood Transfusion Practice

More information

British Society of Gastroenterology. St. Elsewhere's Hospital. National Comparative Audit of Blood Transfusion

British Society of Gastroenterology. St. Elsewhere's Hospital. National Comparative Audit of Blood Transfusion British Society of Gastroenterology UK Com parat ive Audit of Upper Gast roint est inal Bleeding and t he Use of Blood Transfusion Extract December 2007 St. Elsewhere's Hospital National Comparative Audit

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published.

More information

OSPITAL IAISON OMMITTEE

OSPITAL IAISON OMMITTEE and the OSPITAL IAISON OMMITTEE for Jehovah s Witnesses Presented by Roy Jackson www.jw.org Many of the techniques developed for use in Jehovah s Witness patients will become standard practice in years

More information

Clinical guideline Published: 13 June 2012 nice.org.uk/guidance/cg141

Clinical guideline Published: 13 June 2012 nice.org.uk/guidance/cg141 Acute upper gastrointestinal bleeding in over 16s: management Clinical guideline Published: June 2012 nice.org.uk/guidance/cg141 NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).

More information

ORBcoN Spring Symposium April 2015

ORBcoN Spring Symposium April 2015 ORBcoN Spring Symposium April 2015 CFPC CoI Templates: Slide 1 Faculty: Gail Murray Relationships with commercial interests: Former Member of the Advisory Board 2012 with Takeda Canada for Feraheme CFPC

More information

Transfusion Triggers. Richard Soutar January 2012

Transfusion 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 information

Major Haemorrhage Protocol. Commentary

Major 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 information

The principle of 1:1:1 blood product use in the resuscitation of trauma victims. K. D. Boffard

The principle of 1:1:1 blood product use in the resuscitation of trauma victims. K. D. Boffard The principle of 1:1:1 blood product use in the resuscitation of trauma victims K. D. Boffard Milpark Hospital Department of Surgery University of the Witwatersrand Johannesburg, South Africa Annual Controversies

More information

MANAGEMENT OF COAGULOPATHY AFTER TRAUMA OR MAJOR SURGERY

MANAGEMENT OF COAGULOPATHY AFTER TRAUMA OR MAJOR SURGERY MANAGEMENT OF COAGULOPATHY AFTER TRAUMA OR MAJOR SURGERY 19th ANNUAL CONTROVERSIES AND PROBLEMS IN SURGERY Thabo Mothabeng General Surgery: 1 Military Hospital HH Stone et al. Ann Surg. May 1983; 197(5):

More information

Laboratory Empowerment. Debbie Asher Adrian Ebbs Transfusion Laboratory Managers, Eastern Pathology Alliance

Laboratory 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 information

Blood Transfusion Guidelines in Clinical Practice

Blood 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 information

Bleeding, Coagulopathy, and Thrombosis in the Injured Patient

Bleeding, Coagulopathy, and Thrombosis in the Injured Patient Bleeding, Coagulopathy, and Thrombosis in the Injured Patient June 7, 2008 Kristan Staudenmayer, MD Trauma Fellow UCSF/SFGH Trauma deaths Sauaia A, et al. J Trauma. Feb 1995;38(2):185 Coagulopathy is Multi-factorial

More information

Massive transfusion: Recent advances, guidelines & strategies. Dr.A.Surekha Devi Head, Dept. of Transfusion Medicine Global Hospital Hyderabad

Massive transfusion: Recent advances, guidelines & strategies. Dr.A.Surekha Devi Head, Dept. of Transfusion Medicine Global Hospital Hyderabad Massive transfusion: Recent advances, guidelines & strategies Dr.A.Surekha Devi Head, Dept. of Transfusion Medicine Global Hospital Hyderabad Massive Hemorrhage Introduction Hemorrhage is a major cause

More information

Patient Blood Management. Marisa B. Marques, MD UAB Department of Pathology November 17, 2016

Patient Blood Management. Marisa B. Marques, MD UAB Department of Pathology November 17, 2016 Patient Blood Management Marisa B. Marques, MD UAB Department of Pathology November 17, 2016 Learning Objectives Upon completion of the session, the participant will: 1) Differentiate between the various

More information

Intraoperative haemorrhage and haemostasis. Dr. med. Christian Quadri Capoclinica Anestesia, ORL

Intraoperative haemorrhage and haemostasis. Dr. med. Christian Quadri Capoclinica Anestesia, ORL Intraoperative haemorrhage and haemostasis Dr. med. Christian Quadri Capoclinica Anestesia, ORL Haemostasis is like love. Everybody talks about it, nobody understands it. JH Levy 2000 Intraoperative Haemorrhage

More information

Coagulation, Haemostasis and interpretation of Coagulation tests

Coagulation, 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 information

My Bloody Talk. Dr Ben Turner MBBS, FANZCA, FCICM The Royal Children s Hospital, Melbourne

My Bloody Talk. Dr Ben Turner MBBS, FANZCA, FCICM The Royal Children s Hospital, Melbourne My Bloody Talk Dr Ben Turner MBBS, FANZCA, FCICM The Royal Children s Hospital, Melbourne Disclosures No conflicts of interest Interest in conflict Blood transfusion Massive transfusion definitions Transfusion

More information

GUIDELINES FOR THE TRANSFUSION OF BLOOD COMPONENTS

GUIDELINES FOR THE TRANSFUSION OF BLOOD COMPONENTS CHILDREN S HOSPITALS AND CLINICS OF MINNESOTA Introduction: GUIDELINES FOR THE TRANSFUSION OF BLOOD COMPONENTS These guidelines have been developed in conjunction with the hospital Transfusion Committee.

More information

Anaemia in the ICU: Is there an alternative to using blood transfusion?

Anaemia in the ICU: Is there an alternative to using blood transfusion? Anaemia in the ICU: Is there an alternative to using blood transfusion? Tim Walsh Professor of Critical Care, Edinburgh University World Health Organisation grading of the severity of anaemia Grade of

More information

Heme (Bleeding and Coagulopathies) in the ICU

Heme (Bleeding and Coagulopathies) in the ICU Heme (Bleeding and Coagulopathies) in the ICU General Topics To Discuss Transfusions DIC Thrombocytopenia Liver and renal disease related bleeding Lack of evidence in managing critical illness related

More information

Major Haemorrhage Transfusion Pathway

Major Haemorrhage Transfusion Pathway Major Haemorrhage Transfusion Pathway SENIOR CLINICIAN ASSESSMENT: DECLARES MAJOR HAEMORRHAGE ( Call for help ( Telephone via switchboard: Consultant or Senior Clinician Duty Anaesthetist Porters (if will

More information

TRANSFUSION GUIDELINES FOR CARDIOTHORACIC UNIT 2006

TRANSFUSION 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 information

John Davidson Consultant in Intensive Care Medicine Freeman Hospital, Newcastle upon Tyne

John Davidson Consultant in Intensive Care Medicine Freeman Hospital, Newcastle upon Tyne John Davidson Consultant in Intensive Care Medicine Freeman Hospital, Newcastle upon Tyne Overview of coagulation Testing coagulation Coagulopathy in ICU Incidence Causes Evaluation Management Coagulation

More information

Blood Management and Protocol Use in Active Bleeding

Blood Management and Protocol Use in Active Bleeding Blood Management and Protocol Use in Active Bleeding John A. Norton, DO Assistant Professor Clinical Department of Anesthesiology The Ohio State University Wexner Medical Center Acknowledgements Stephanie

More information

Patient Blood Management and alternatives to transfusion

Patient Blood Management and alternatives to transfusion Patient Blood Management and alternatives to transfusion Patient Blood Management and the alternatives to transfusion and when these should be used Learning Outcomes Explain techniques that can be used

More information

Administration of blood components. Tina Parker - Transfusion Practitioner

Administration 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 information

Massive Transfusion. MPQC Spring Summit April 29, Roger Belizaire MD PhD

Massive Transfusion. MPQC Spring Summit April 29, Roger Belizaire MD PhD Massive Transfusion MPQC Spring Summit April 29, 2015 Roger Belizaire MD PhD Take home points 1. Blood is always available. Requests for massive transfusion or emergency release typically only require

More information

Blood Product Utilization A Mythbusters! Style Review. Amanda Haynes, DO 4/28/18

Blood Product Utilization A Mythbusters! Style Review. Amanda Haynes, DO 4/28/18 Blood Product Utilization A Mythbusters! Style Review Amanda Haynes, DO 4/28/18 Objectives Describe concepts in Patient Blood Management Review common misconceptions surrounding blood transfusion Summarize

More information

NICE guideline Published: 18 November 2015 nice.org.uk/guidance/ng24

NICE 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 information

Document for Obstetric Patients Who Refuse Consent for Blood and Blood Product Administration, Including Jehovah s Witnesses

Document for Obstetric Patients Who Refuse Consent for Blood and Blood Product Administration, Including Jehovah s Witnesses Document for Obstetric Patients Who Refuse Consent for Blood and Blood Product Administration, Including Jehovah s Witnesses Patient addressograph Label This form must only be used for the refusal of blood

More information

Blood is serious business

Blood 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 information

Crossmatching and Issuing Blood Components; Indications and Effects.

Crossmatching 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 information

Managing Coagulopathy in Intensive Care Setting

Managing 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 information

ERYTHROPOIETIC STIMULATING AGENTS IN THE ICU: A MOVING PUZZLE

ERYTHROPOIETIC STIMULATING AGENTS IN THE ICU: A MOVING PUZZLE ERYTHROPOIETIC STIMULATING AGENTS IN THE ICU: A MOVING PUZZLE WEIQIANG GAO HEM/ONC FELLOW FACULTY DISCUSSANT SIOBAN KEEL, MD OCT. 24, 2014 CASE PRESENTATION 25 F, a Jehovah s witness, w/ h/o synovial sarcoma

More information

Patient Blood Management: Enough is Enough

Patient Blood Management: Enough is Enough Patient Blood Management: Enough is Enough Richard Benjamin, MBChB, PhD, FRCPath Professor of Pathology Georgetown University Medical Center Washington, D.C. Chief Medical Officer Cerus Corporation Concord,

More information

Chapter 3 MAKING THE DECISION TO TRANSFUSE

Chapter 3 MAKING THE DECISION TO TRANSFUSE Chapter 3 MAKING THE DECISION TO TRANSFUSE PRACTICE POINTS Determine the best treatment for the patient which may include transfusion. Treat the cause of cytopenia (anaemia or thrombocytopenia) or plasma

More information

Patient Blood Management: Exploring the Options. Perioperative Blood Management Services November 4, 2011

Patient Blood Management: Exploring the Options. Perioperative Blood Management Services November 4, 2011 Patient Blood Management: Exploring the Options Heather E E. Mingo RN RN, SNP Perioperative Blood Management Services November 4, 2011 Conflict of Interest I have no financial relationships or involvement

More information

Approach to disseminated intravascular coagulation

Approach 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 information

Patient Blood Management in the Netherlands: Between practice and evidence

Patient Blood Management in the Netherlands: Between practice and evidence Patient Blood Management in the Netherlands: Between practice and evidence Marian van Kraaij MD PhD hematologist transfusion medicine specialist Department of Transfusion Medicine, Sanquin Blood Bank Radboud

More information

Gastro-Intestinal Bleeding- Interventional Radiology turning off the tap. Simon McPherson, Vascular Interventional Radiologist, Leeds

Gastro-Intestinal Bleeding- Interventional Radiology turning off the tap. Simon McPherson, Vascular Interventional Radiologist, Leeds Gastro-Intestinal Bleeding- Interventional Radiology turning off the tap Simon McPherson, Vascular Interventional Radiologist, Leeds Scale UK 100,000 /year Commonest Vascular IR on-call 75% UGIB 65% NVUGIB

More information

Advances in Transfusion and Blood Conservation

Advances in Transfusion and Blood Conservation Advances in Transfusion and Blood Conservation Arman Kilic, MD Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD No relevant financial relationships to disclose.

More information

Patient Blood Management Are you providing this? Jeannie Callum, BA, MD, FRCPC Associate Professor, University of Toronto

Patient Blood Management Are you providing this? Jeannie Callum, BA, MD, FRCPC Associate Professor, University of Toronto Patient Blood Management Are you providing this? Jeannie Callum, BA, MD, FRCPC Associate Professor, University of Toronto Disclosures Relevant relationships with commercial entities: Octapharma, CSL Behring

More information

WELCOME. Evaluation Summary

WELCOME. Evaluation Summary WELCOME Evaluation Summary 489 delegates from 40 countries Delegate s specialty 239 respondents Delegate s professional activity 208 respondents Overall Evaluation This symposium was helpful for your clinical

More information

GUIDELINES FOR MANAGEMENT OF BLEEDING AND EXCESSIVE ANTICOAGULATION WITH ORAL ANTICOAGULANTS

GUIDELINES FOR MANAGEMENT OF BLEEDING AND EXCESSIVE ANTICOAGULATION WITH ORAL ANTICOAGULANTS GUIDELINES FOR MANAGEMENT OF BLEEDING AND EXCESSIVE ANTICOAGULATION WITH ORAL ANTICOAGULANTS This guideline covers the management of patients being treated with Vitamin K antagonists (VKA): Warfarin Acenocoumarol

More information

Preparing for Patients at High Risk of Transfusion

Preparing for Patients at High Risk of Transfusion 18/10/2017 Preparing for Patients at High Risk of Transfusion Jane Ottens. B.Sc., CCP ( Aust) Ashford Hospital, South Australia Preparing for Patients at High Risk of Transfusion Jane Ottens. B.Sc., CCP

More information

Haematology and Transfusion

Haematology and Transfusion Haematology and Transfusion Prof Dr Wolfram Engelhardt Anaesthesiology and Intensive Care Medicine Offenburg Hospital, Germany dr.w.engelhardt@gmail.com James Blundell 1828 Lancet 1828; 11:321 Erythrocytes

More information

The research questions are presented in priority order, and are further elaborated with lay summaries and three-part questions where applicable.

The research questions are presented in priority order, and are further elaborated with lay summaries and three-part questions where applicable. Top 30 Emergency Medicine Research Priorities 23 January 2017 The rankings were established by consensus at the final prioritisation workshop run by the James Lind Alliance Emergency Medicine Priority

More information

Patient blood management and perioperative anaemia

Patient blood management and perioperative anaemia BJA Education, 17 (1): 28 34 (2017) doi: 10.1093/bjaed/mkw061 Matrix referenece 1I05, 2A05, 3I00 Patient blood management and perioperative anaemia S V Thakrar MBBS BSc(Hons) MRCP FRCA 1, *, B Clevenger

More information

The Concept of Patient Blood Management Daniela Filipescu, MD, PhD, DEAA

The Concept of Patient Blood Management Daniela Filipescu, MD, PhD, DEAA The Concept of Patient Blood Management Daniela Filipescu, MD, PhD, DEAA Associate Professor of Anaesthesia & Intensive Care Medicine Department of Cardiac Anaesthesia & Intensive Care Medicine II Emergency

More information

Haematology and Transfusion

Haematology and Transfusion Haematology and Transfusion dr.w.engelhardt@gmail.com Wolfram Engelhardt Offenburg, Germany James Blundell 1828 Diameter 6-8 µm Erythrocytes Women: Men: 4-5 x 10 6 /µl 5-6 x 10 6 /µl live 100-120 days

More information

Bloodless Medicine and Surgery Program. The Only Bloodless Medicine and Surgery Program in the D.C. Area

Bloodless Medicine and Surgery Program. The Only Bloodless Medicine and Surgery Program in the D.C. Area Bloodless Medicine and Surgery Program The Only Bloodless Medicine and Surgery Program in the D.C. Area 3 Blood transfusions are performed to replace blood that has been lost during surgery, an injury

More information

Guidance for management of bleeding in patients taking the new oral anticoagulant drugs: rivaroxaban, dabigatran or apixaban

Guidance for management of bleeding in patients taking the new oral anticoagulant drugs: rivaroxaban, dabigatran or apixaban Guidance for management of bleeding in patients taking the new oral anticoagulant drugs: rivaroxaban, dabigatran or apixaban Purpose The aim of this guidance is to outline the management of patients presenting

More information

Effective Date: Approved by: Laboratory Director, Jerry Barker (electronic signature)

Effective Date: Approved by: Laboratory Director, Jerry Barker (electronic signature) 1 of 5 Policy #: 702 (PHL-702-05) Effective Date: 9/30/2004 Reviewed Date: 8/1/2016 Subject: TRANSFUSION GUIDELINES Approved by: Laboratory Director, Jerry Barker (electronic signature) Approved by: Laboratory

More information

Risk assessment in UGIB: recent PCI & ACS. Dr Martin James PhD FRCP October 20 th 2016 Nottingham Endoscopy Masterclass

Risk assessment in UGIB: recent PCI & ACS. Dr Martin James PhD FRCP October 20 th 2016 Nottingham Endoscopy Masterclass Risk assessment in UGIB: recent PCI & ACS Dr Martin James PhD FRCP October 20 th 2016 Nottingham Endoscopy Masterclass Clinical scenario 65 yr male Previous smoker, hyperlipidaemia, DM PCI < 48 hours Dual

More information

Damage Control Resuscitation. VGH Trauma Rounds 2018 Harvey Hawes

Damage Control Resuscitation. VGH Trauma Rounds 2018 Harvey Hawes Damage Control Resuscitation VGH Trauma Rounds 2018 Harvey Hawes Example Case 25yo F in motor vehicle collision at high speed Picked up at scene by Helicopter EMS unit Initial vital signs: HR 134 BP 88/42

More information

A Patient s guide to. Blood Transfusions and Human Tissue Transplant

A Patient s guide to. Blood Transfusions and Human Tissue Transplant A Patient s guide to Blood Transfusions and Human Tissue Transplant Why might I need a blood transfusion? Blood transfusions are given to replace blood lost in surgery or to treat anaemia (lack of red

More information

Blood Transfusions in Children with Haemoglobinopathies

Blood Transfusions in Children with Haemoglobinopathies Blood Transfusions in Children with Haemoglobinopathies Version: 2 Date: 22 nd April 2010 Authors: Responsible committee or Director: Review date: Target audience: Stakeholders/ committees involved in

More information

Transfusions in Acute Care Too Little?

Transfusions in Acute Care Too Little? Transfusions in Acute Care Too Little? Keyvan Karkouti MD FRCPC MSc Associate Professor Department of Anesthesia; Department of Health Policy, Management, and Evaluation; University of Toronto Scientist

More information

and Securing the Blood Supply Under Clinical Transfusion Governance

and Securing the Blood Supply Under Clinical Transfusion Governance Patient Blood Management and Securing the Blood Supply Under Clinical Transfusion Governance Dr. Joan Power, NHO Conference October 2018 IBTS notices of Blood Shortage 2017 ( n=17) 2 TRENDS OVER TIME Irl

More information

Dr Marina Karakantza Consultant Haematologist, NHSBT

Dr 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 information

Spanish Consensus Statement on alternatives to allogeneic blood transfusion: the 2013 update of the "Seville Document"

Spanish Consensus Statement on alternatives to allogeneic blood transfusion: the 2013 update of the Seville Document R Spanish Consensus Statement on alternatives to allogeneic blood transfusion: the 2013 update of the "Seville Document" Santiago R. Leal-Noval 1, Manuel Muñoz 2, Marisol Asuero 3, Enric Contreras 3, José

More information

A Patient s guide to. Blood Transfusions and Human Tissue Transplant

A Patient s guide to. Blood Transfusions and Human Tissue Transplant A Patient s guide to Blood Transfusions and Human Tissue Transplant Why might I need a blood transfusion? Blood transfusions are given to replace blood lost in surgery or to treat anaemia (lack of red

More information

the bleeding won t stop? Liane Manz RN, BScN, CNCC(c) Royal Alexandra Hospital

the bleeding won t stop? Liane Manz RN, BScN, CNCC(c) Royal Alexandra Hospital What do you do when the bleeding won t stop? Teddie Tanguay RN, MN, NP, CNCC(c) Teddie Tanguay RN, MN, NP, CNCC(c) Liane Manz RN, BScN, CNCC(c) Royal Alexandra Hospital Outline Case study Normal coagulation

More information

Unrestricted. Dr ppooransari fellowship of perenatalogy

Unrestricted. Dr ppooransari fellowship of perenatalogy Unrestricted Dr ppooransari fellowship of perenatalogy Assessment of severity of hemorrhage Significant drops in blood pressure are generally not manifested until substantial bleeding has occurred, and

More information

Pre-operative Anaemia Colorectal and Orthopaedic Surgery

Pre-operative Anaemia Colorectal and Orthopaedic Surgery Pre-operative Anaemia Colorectal and Orthopaedic Surgery Dr Simon Rang Consultant Anaesthetist East Kent Hospitals NHS Trust Dreamland Pre-operative Anaemia Anaemia is a perioperative risk factor Perioperative

More information

How can ROTEM testing help you in trauma?

How can ROTEM testing help you in trauma? How can ROTEM testing help you in trauma? Complicated bleeding situations can appear intra and post operatively. They can be life-threatening and always require immediate action. A fast differential diagnosis

More information

Oral anticoagulant agent-associated bleeding events reporting system (ORANGE study)

Oral anticoagulant agent-associated bleeding events reporting system (ORANGE study) Oral anticoagulant agent-associated bleeding events reporting system (ORANGE study) Laura Green 1,2,3, Joan Morris 1, Raza Alikhan 4, Nicola Curry 5, Rhona Maclean 6, Khalid Saja 7, Simon Stanworth 3,5,

More information

2/2/2011. Blood Components and Transfusions. Why Blood Transfusion?

2/2/2011. Blood Components and Transfusions. Why Blood Transfusion? Blood Components and Transfusions Describe blood components Identify nursing responsibilities r/t blood transfusion Discuss factors r/t blood transfusion including blood typing, Rh factor, and cross matching

More information

YEREVAN STATE MEDICAL UNIVERSITY DEPARTMENT OF HEMATOLOGY COURSE DESCRIPTION HEMATOLOGY

YEREVAN STATE MEDICAL UNIVERSITY DEPARTMENT OF HEMATOLOGY COURSE DESCRIPTION HEMATOLOGY 1. Module/unit Code II. 1.2. 2. Module/unit Title Hematology 3. Subject Field Internal Diseases Group 4. Faculty/Department General Medicine, Department of Hematology 5. Programme(s) to which the Doctor

More information

Clinical and Cost Effectiveness of Darbepoetin alfa in Cancer Treatment-induced Anaemia

Clinical and Cost Effectiveness of Darbepoetin alfa in Cancer Treatment-induced Anaemia Clinical and Cost Effectiveness of Darbepoetin alfa in Cancer Treatment-induced Anaemia 8 th November 2004 A report for the National Institute for Clinical Excellence prepared by Amgen Ltd. EXECUTIVE SUMMARY

More information

Sign up to receive ATOTW weekly

Sign up to receive ATOTW weekly MANAGEMENT OF MAJOR HAEMORRHAGE PART ONE: INITIAL RESPONSE ANAESTHESIA TUTORIAL OF THE WEEK 136 1 ST JUNE 2009 Katrina Webster (Senior Registrar in Anaesthesia) Royal Hobart Hospital, Tasmania, Australia.

More information

Blood and blood component therapy in the critically ill patient

Blood and blood component therapy in the critically ill patient Blood and blood component therapy in the critically ill patient Dr Liesel Bösenberg Specialist Physician and Fellow in Critical Care Kalafong Hospital Points that we shall ponder Transfusion triggers EGDT

More information

PBM: The Future of Transfusion December 6 th 2012 East of England RTC. Sue Mallett Royal Free London NHS Foundation Trust

PBM: The Future of Transfusion December 6 th 2012 East of England RTC. Sue Mallett Royal Free London NHS Foundation Trust PBM: The Future of Transfusion December 6 th 2012 East of England RTC Sue Mallett Royal Free London NHS Foundation Trust Patient Blood Management The 3 Pillars Pre-operative optimization of anaemia Minimizing

More information

Dr Shikha Chattree Haematology Consultant Sunderland Royal infirmary

Dr Shikha Chattree Haematology Consultant Sunderland Royal infirmary Dr Shikha Chattree Haematology Consultant Sunderland Royal infirmary Increasing use of Novel Oral Anticoagulants (NOACs) in the management of prophylaxis and management of venous thromboembolism and in

More information

Management of Challenging Bleeding: Patients with Coagulopathy

Management of Challenging Bleeding: Patients with Coagulopathy Management of Challenging Bleeding: Patients with Coagulopathy Joanne E Joseph Department of Haematology, SydPath St Vincent s Hospital University of NSW Sydney First and foremost.. It helps to know which

More information

Thrombocytopenia and Chronic Liver Disease

Thrombocytopenia and Chronic Liver Disease Thrombocytopenia and Chronic Liver Disease Severe thrombocytopenia (platelet count

More information

TRANSFUSION SUPPORT IN HEPATOBILIARY AND PANCREATIC SURGERIES

TRANSFUSION SUPPORT IN HEPATOBILIARY AND PANCREATIC SURGERIES TRANSFUSION SUPPORT IN HEPATOBILIARY AND PANCREATIC SURGERIES Dr.K.C.Usha Professor & Head Dept: Of Transfusion Medicine & Director, Model Blood Bank Government Medical College Trivandrum,Kerala INTRODUCTION

More information

EMSS17: Bleeding patients course material

EMSS17: Bleeding patients course material EMSS17: Bleeding patients course material Introduction During the bleeding patients workshop at the Emergency Medicine Summer School 2017 (EMSS17) you will learn how to assess and treat bleeding patients

More information

Approach to bleeding disorders &treatment. by RAJESH.N General medicine post graduate

Approach to bleeding disorders &treatment. by RAJESH.N General medicine post graduate Approach to bleeding disorders &treatment by RAJESH.N General medicine post graduate 2 Approach to a patient of bleeding diathesis 1. Clinical evaluation: History, Clinical features 2. Laboratory approach:

More information

Use of Prothrombin Complex Concentrate to Reverse Coagulopathy Rio Grande Trauma Conference

Use of Prothrombin Complex Concentrate to Reverse Coagulopathy Rio Grande Trauma Conference Use of Prothrombin Complex Concentrate to Reverse Coagulopathy Rio Grande Trauma Conference John A. Aucar, MD, MSHI, FACS, CPE EmCare Acute Care Surgery Del Sol Medical Center Associate Professor, University

More information

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 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 information

Anaemia & Cancer. John de Vos Consultant Haematologist RSCH

Anaemia & Cancer. John de Vos Consultant Haematologist RSCH Anaemia & Cancer John de Vos Consultant Haematologist RSCH overview Definitions & setting the scene Causes Consequences Biology Treatment Personal approach Patient Clinical team Anaemia - Definition :

More information

Cancer associated thrombosis palliative care and the end of life. Tracy Anderson May 2017

Cancer associated thrombosis palliative care and the end of life. Tracy Anderson May 2017 Cancer associated thrombosis palliative care and the end of life Tracy Anderson May 2017 Treatment at the end of life Can be challenging to know what treatments are appropriate Benefit vs burden Patients

More information

MASSIVE 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 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 information

STATUS OF EARLY MORTALITY IN NEWLY DIAGNOSED CASES OF ACUTE PROMYELOCYTIC LEUKAEMIA (APL) IN BSMMU HOSPITAL

STATUS OF EARLY MORTALITY IN NEWLY DIAGNOSED CASES OF ACUTE PROMYELOCYTIC LEUKAEMIA (APL) IN BSMMU HOSPITAL STATUS OF EARLY MORTALITY IN NEWLY DIAGNOSED CASES OF ACUTE PROMYELOCYTIC LEUKAEMIA (APL) IN BSMMU HOSPITAL RAHMAN F 1, YUNUS ABM 2, KABIR AL 3, BEGUM M 4, AZIZ A 3, SHAH S 3, RAHMAN F 5, RAHMAN MJ 6 Abstract:

More information

Third Pillar. Tolerance of Anaemia

Third Pillar. Tolerance of Anaemia Perioperative Patient Blood Management Third Pillar Tolerance of Anaemia Ross Kerridge John Hunter Hospital Newcastle Blood Transfusion is exciting.. Implications of Current Research New Technology Multidisciplinary

More information

Patient Blood Management. Peter Freeman Patient Blood Management Officer Clinical Operations Hunter New England LHD.

Patient Blood Management. Peter Freeman Patient Blood Management Officer Clinical Operations Hunter New England LHD. Patient Blood Management Peter Freeman Patient Blood Management Officer Clinical Operations Hunter New England LHD. 1 National Standard 7: Blood & Products To ensure that the patients who receive blood

More information

Components of Blood. N26 Blood Administration 4/24/2012. Cabrillo College ADN/C. Madsen RN, MSN 1. Formed elements Cells. Plasma. What can we give?

Components of Blood. N26 Blood Administration 4/24/2012. Cabrillo College ADN/C. Madsen RN, MSN 1. Formed elements Cells. Plasma. What can we give? Components of Blood Formed elements Cells Erythrocytes (RBCs) Leukocytes (WBCs) Thrombocytes (platelets) Plasma 90% water 10% solutes Proteins, clotting factors 1 What can we give? Whole blood Packed RBC

More information

Guideline for the Management of Upper Gastrointestinal Bleeding in Children

Guideline for the Management of Upper Gastrointestinal Bleeding in Children Guideline for the Management of Upper Gastrointestinal Bleeding in Children 1. Introduction Upper gastrointestinal (UGI) bleeding in children poses a challenge to paediatricians and paediatric surgeons.

More information

Survey of Massive Blood Loss In the North East of England 2013

Survey 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 information

Early Management of the Patient with Acute GI Bleeding

Early Management of the Patient with Acute GI Bleeding Early Management of the Patient with Acute GI Bleeding Dr Sarah Hearnshaw Consultant Gastroenterologist Newcastle upon Tyne NHS Trust Go through.. Stats Transfusion / resuscitation PPIs When to call us

More information

Transfusion 2004: Current Practice Standards. Kay Elliott, MT (ASCP) SBB SWMC Transfusion Service

Transfusion 2004: Current Practice Standards. Kay Elliott, MT (ASCP) SBB SWMC Transfusion Service Transfusion 2004: Current Practice Standards Kay Elliott, MT (ASCP) SBB SWMC Transfusion Service Massive Transfusion Protocol (MTP) When should it be activated? Massive bleeding i.e. loss of one blood

More information

Iron Deficiency Anaemia but Why? Dr LAU Ching-wa Specialist in Haematology Blood Transfusion Service

Iron Deficiency Anaemia but Why? Dr LAU Ching-wa Specialist in Haematology Blood Transfusion Service Iron Deficiency but Why? Dr LAU Ching-wa Specialist in Haematology Blood Transfusion Service 1 3 Questions 1. Is anaemia incurable in my patient? 2. Is anaemia unavoidable in my bleeding patient? 3. Is

More information

Chest diseases Hospital Laboratory Hematology Practice guidelines

Chest diseases Hospital Laboratory Hematology Practice guidelines Chest diseases Hospital Laboratory Hematology Practice guidelines Title RBCs transfusion in Adults SOP Code Policy Owner Hematology Unit Section Hematology Prepared By Dr. Taher Ahmed Abdelhameed Issuing

More information

Transfusion Pitfalls. Objectives. Packed Red Blood Cells. TRICC trial (subgroups): Is transfusion always good? Components

Transfusion Pitfalls. Objectives. Packed Red Blood Cells. TRICC trial (subgroups): Is transfusion always good? Components Objectives Transfusion Pitfalls Gregory W. Hendey, MD, FACEP Professor and Chief UCSF Fresno, Emergency Medicine To list risks and benefits of various blood products To discuss controversy over liberal

More information