Third Pillar. Tolerance of Anaemia
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- Mitchell Butler
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1 Perioperative Patient Blood Management Third Pillar Tolerance of Anaemia Ross Kerridge John Hunter Hospital Newcastle
2 Blood Transfusion is exciting.. Implications of Current Research New Technology Multidisciplinary Complexity Variation in Clinical Practice Resource Implications Emotional Issue Political Minefield AND A MODERN MIRACLE..
3 Coming soon to a Hospital near you :- BLOOD TRANSFUSION IS A MODERN MIRACLE.. Mindless Blood Transfusion
4 I don t want to be a Zombie.. What do I need to know about blood transfusion and perioperative bleeding?
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6 Newcastle
7 An Alternative to Zombie Transfusion. Patient Blood Management James Isbister
8 Hazards of Transfusion. Mismatched Transfusion Infection Immunomodulation (TRIM) Sepsis TRALI TACO Haemodynamic Hazards of Volutransfusion Poorly Managed Massive Transfusion etc etc etc And it isn t good for you anyway.
9 I can find out what I need to know about blood transfusion and perioperative bleeding BUT IS KNOWING WHAT TO DO ENOUGH?
10 The Challenge:- Knowledge into Practice Preoperative Patient Optimisation: Anaemia Patient Education & Counselling Cell Salvage, Blood Collection and Reinfusion (Waste Avoidance) Massive Haemorrhage Blood Components Point of Care Testing & Thromboelastography Electronic Issue & Remote Release Back to Basics Simple Hazards of Transfusion The Age of Blood Appropriate Transfusion Triggers WHY WON T DOCTORS CHANGE???? How do we get Doctors to change?
11 The Challenge:- Knowledge into Practice Preoperative Patient Optimisation: Anaemia Patient Education & Counselling Cell Salvage, Blood Collection and Reinfusion (Waste Avoidance) Massive Haemorrhage Blood Components Point of Care Testing & Thromboelastography Electronic Issue & Remote Release Back to Basics Simple Hazards of Transfusion The Age of Blood Appropriate Transfusion Triggers WHY WON T DOCTORS CHANGE???? How do we get Doctors to change?
12 Simple Hazards of Transfusion Giving the Wrong Blood
13 Back to Basics!! (And remember Wrong Blood in Tube as well) It can happen to anyone
14 The Hazard of the Future Age of Stored Blood The Elephant in the Blood Bank..
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16 What will be the result of research into effects of Age of Stored Blood?
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18 The Age of Stored Blood Problem It could get messy..
19 An Alternative to Zombie Transfusion. Patient Blood Management Increased Tolerance of Anaemia James Isbister
20 Tolerance of Anaemia?? Where have I heard that before???
21 Special People..
22 It s my patient.. and I want some blood!
23 Mindless Blood Transfusion
24 Transfusion practice varies widely in cardiac surgery: Results from a national registry. Zoe K. McQuilten & et al. J Thorac Cardiovasc Surg 2014;147: Analysis of 42,743 adult patients who underwent 43,482 procedures from 2005 to 2011 at 25 Australian hospitals. After adjustment for various patient and procedure characteristics, transfusion rates varied across hospitals for > 1 RBC unit from 22% to 67%, >5 RBC units from 5% to 25%, >1 PLT dose from 11% to 39%, >1 FFP dose from 11% to 48% and >1 CRYO dose from 1% to 20%. Conclusions: Variation in transfusion of all components and large volume RBC was identified, even after adjustment for patient and procedural factors known to influence transfusion, and this was not explained by hospital characteristics. Wide Variation in Practice
25 Transfused patients die in ICU? TRICC - Hb 7-9 equal or better than Hb 10-12, especially in younger, healthier ICU patients, and those without cardiac disease
26 Transfusions kill patients with GI Bleeds?? Randomised 921 patients, , Barcelona Restrictive Transfusion <Hb7; Liberal Transfusion <Hb9; Restrictive t/f significantly improved outcomes in acute GI bleeds.
27 Cochrane 2013 Transfusion Thresholds
28 Transfusions kill patients incrementally? Banbury MK et al. Transfusion increases the risk of postoperative infection after cardiac surgery. J Am Col Surg 2006;202: Koch CG et al. Persistent effect of red cell transfusion on health-related quality of life after cardiac surgery. Ann Thorac Surg 2006;82:13-20 Etc etc etc. Association or Causation? Blood Transfusions fulfill the Bradford Hill criteria as causative of adverse outcome (Isbister et al 2012)
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32 Not enough to know about blood transfusion and perioperative bleeding We need to know how to lead change in clinical practice Why Won t Doctors Change what they do?
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34 People make decisions based on their emotions and then use their rationality to justify the decision they have made Dee Madigan - Marketing Guru ABC TV The Gruen Transfer
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40 Sending the Wrong Message?
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43 Sending the wrong message?
44 Is it the Way We Say Things?. Safeguarding our precious blood supply Transfusion Avoidance Restrictive Transfusion Threshold Tolerance of Anaemia without transfusion Transfusion Alternatives How Low can you go without transfusion? Don t do Drugs Just Say No Save yourself until you are married.
45 The Way We Should Say Things?. In severe symptomatic anaemia, the risk of transfusion may have be accepted.. If normal medical treatment has not been managed appropriately, the patient may have to be transfused Sometimes sick old people needs drugs to keep them alive Marriage is the double bed after the hurlyburly of the Chaise-lounge
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47 Mean while back in Newcastle We are proud of what we do..
48 Newcastle is a long-standing leader in Blood Management What s the secret????
49 Dr Peter Hendry AO Founding Director, Newcastle Blood Bank, 1947
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51 Dr Peter Hendry AO. Founding Director, Newcastle Blood Bank, 1947 (Interviewed February 2013)
52 Dr Peter Hendry AO. Founding Director, Newcastle Blood Bank, 1947 (Interviewed February 2013)
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55 Dr D Sandra Deveridge, Haematologist Extraordinaire
56 We Stand on the Shoulders of Giants.. It is not a Blood Bank, but a Blood Consultation Service The Scientists always know that the Haematologists are there to back them up..
57 What does this mean for me? THINK! Stay away from Zombies Transfusion is hazardous Preoperative Iron Therapy Avoid blood loss & wastage Fibrinogen is important! How will we allocate fresh blood? The way we talk and act matters Multidisciplinary Teamwork
58 Thank You
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