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

Transcription

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

2 Massive Transfusion Protocol (MTP) When should it be activated? Massive bleeding i.e. loss of one blood volume with continuing need for transfusion. Massive blood loss with profound hemorrhagic hypovolemic shock. Severe injury to or ischemia of the liver Prolonged PT (INR>1.5), depressed fibrinogen levels (<100 mg/dl) or platelet count (<100,000/mm 3 ) on admission or during resuscitation accompanied by hemorrhage. Ruptured abdominal aortic aneurysm, amniotic fluid embolism, septic shock, and bleeding from other causes.

3 How is the MTP activated? By physician Requires phone call directly to a blood bank technologist

4 What happens at activation? Blood Bank Technologist: Identifies the patient and secures sample for compatibility testing Designates a red cell processor Designates a MTP coordinator Notifies the hematology and coagulation labs Thaws 4 FFP Ensures adequate platelet inventory Requests sample for baseline PT, PTT, Fibrinogen, Platelet

5 Blood Product Issue Massive Transfusion Pack issued every 15 minutes Includes 4 red blood cells Platelets, FFP, Cryo included when indicated by lab results

6 Transfusion Triggers FFP INR>1.5 send 2 INR>2.0 send 4 Platelets Platelets <100,000 Cryoprecipitate Fibrinogen <100 mg/dl

7 Sample Collection Every 30 minutes Ensures current lab results Reflect the patients current coagulation status Prevents a surprise coagulapathy Reduces units transfused Conserves the blood supply

8 Results 1st call to blood bank 2nd call to patient site (OR)

9 Transport Requires dedicated runner for product issue and sample delivery

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11 Documentation Designated recorder at patient site documents units transfused and lab results Blood Bank MTP coordinator documents unit issue time, sample collect time and lab results

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13 Communication Requires direct communication between blood bank and the patient site Updates: ensure justified non-red cell product issue prevent red cell stockpile ensure 30 minute sample collection intervals

14 SWMC DATA Year RBC S (average) Components (average) Justified (%)

15 A significant portion of FFP is transfused inappropriately American Society of Anesthesiology Practice Guidelines, 1996

16 :.generalized bleeding in the setting of trauma has been found more often in association with thrombocytopenia than with coagulation factor depletion. Kruskall, et al

17 SWMC DATA Procedure AAA GI Bleed Post. Part. Bl Rupt. Spleen Whip. Proc Rupt. Uterus Total

18 SWMC DATA Year Sample Collection min of 9 cases of 8 cases of 13 cases % of results TAT < 30 min

19 Blood Products Cryoprecipitate Prepooled product Fibrinogen concentration is equivalent to the previous pool of 10 Raises the fibrinogen 45 mg/dl Decreased TAT Decreased donor exposure

20 Blood Products Platelets Apheresis Platelets Single donation Equivalent to 6-8 single donor platelet concentrates Increases the platelet count 30,000-40,000 Decreased TAT Decreased donor exposure

21 Patient Safety JCAHO The Hospital collects data that measure the performance of each of the following potentially high-risk processes Blood and blood product use Std. PI 1.10

22 Patient Safety JCAHO Blood Usage Measurement - An Activity that entails measuring, assessing, improving the ordering, distributing and monitoring of blood and blood components.

23 TRANSFUSION RISKS Viral Infection HCV 1 in 1,000,000 HBV 1 in 1,000,000 HIV 1 in 2,000,000 Bacterial Contamination Platelets: Risk of death is 1 in 12,000-60,000 RBC s: Risk of contamination is 1 in 1,000,000

24 TRANSFUSION RISKS Transfusion Reactions ABO Incompatible Transfusions Risk of death is 1 in 160,000 Febrile and allergic Reactions occurs in 10-30% of all transfusions Usually not serious

25 TRANSFUSION RISKS Transfusion Related Acute Lung Injury (TRALI) Acute respiratory distress Severe bilaterial pulmonary edema Severe hypoxia Tachycardia Fever Hypotension Cyanosis

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27 Mission To consistently improve in our process to provide blood products to our patients This includes assuring effective and safe products that they are transfused according to current practice standards that there is an adequate supply