Major Haemorrhage Protocol. Commentary
|
|
- Barbra Cummings
- 5 years ago
- Views:
Transcription
1 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 Dunn, Consultant Anaesthetist, Monklands Dr Duncan Allen, Consultant Anaesthetist, Hairmyres Dr Donald MacLean, Consultant Anaesthetist, Wishaw Dr Pamela Paterson, Lead Clinician for Transfusion Review Date December 2009
2 Objective To ensure that a simple guideline exists to aid in the treatment of a major haemorrhage presenting to any NHS Lanarkshire acute hospital site. The protocol should run in accordance with previously established NHS Lanarkshire policies for the checking and administration of blood products. This commentary should be read in conjunction with the relevant site specific summarised protocol. Rationale Quality Improvement Scotland (QIS) recommend that protocols are in place in individual hospitals to facilitate a multidisciplinary approach to acute blood loss. The protocol is based on the guidelines produced by the British Committee for Standards in Haematology 1. This protocol is intended for use in Lanarkshire s Acute Hospitals for treating major haemorrhage in non-obstetric cases. A separate protocol is available for the Management of Obstetric Haemorrhage. It should be ensured that the patient does not have an advance directive refusing blood and blood products prior to transfusion. Resuscitate Recommendations Priority should be given to ensuring that patients are adequately resuscitated with patent airway, satisfactory ventilation and supplementary oxygen before assessment of circulation. Contact senior personnel Good communication is essential during a major haemorrhage. Trainees should contact their seniors early. Preferably one member of the clinical team should be identified as a coordinator to liaise with the blood bank and the Consultant Haematologist, allowing for more effective communication. Restore Circulating Volume/Laboratory Tests Circulatory support should be given as necessary, with a minimum of two large-bore peripheral cannulae being inserted to allow rapid fluid resuscitation (via a blood warmer). Estimated blood loss and physiological parameters including heart rate, blood pressure and peripheral perfusion should be used to guide initial fluid therapy. 2
3 Baseline observations should be undertaken and routine bloods sent (including FBC, U+Es, coagulation screen, ABGs and cross-match specimen, ensuring correct patient identification details). Recent studies show no survival benefit from colloids as opposed to crystalloids. 2 The volume of crystalloids needed to be administered is at least three times the blood volume lost. The volume of colloid needed is equivalent to the blood volume lost. Dextrose should never be used for fluid resuscitation in this situation. It is important at all times to ensure correct patient identification and to check the patient s wristband before administering blood products. For unidentified patients a minimum data set of gender and a unique identifier number is required. Throughout resuscitation, routine blood samples (as above) should be repeated at least every four hours and after every major therapeutic intervention. In addition, calcium should be measured after infusion of FFP (fresh frozen plasma), platelets and red cells as citrate anticoagulant may bind calcium, especially if hypothermic or acidotic. Treat hypocalcaemia with 10ml of 10% calcium gluconate as a slow IV bolus. Hypothermia should be prevented by blood warmers and warming blankets. Arrest Bleeding Senior staff from surgical, anaesthetic and haematological departments should be alerted early, allowing formulation of a management plan and surgical / radiological intervention as necessary. Time to definitive surgery should be minimised. Simple manoeuvres such as elevation of a limb and direct pressure should be considered. Institute Invasive Monitoring Invasive monitoring should be instituted as soon as practical and by those competent in doing so, with fluid replacement guided by pulse, blood pressure, CVP and urine output (aiming for >0.5ml/kg/hour.). Central venous access and arterial lines may be required. Consider transferring the patient to HDU/ITU/theatre as appropriate. Request suitable blood products: Red Cells (discuss with haematology BMS & declare major haemorrhage) No definitive Hb trigger value exists for transfusion in acute haemorrhage, but the American Society of Anaesthesiologists Task Force on Blood Component Therapy suggest transfusion is rarely indicated if Hb is >10g / dl, but is always indicated if Hb < Current consensus favours an Hb of >8.0. Allowances 3
4 must also be made for haemodilution, and Hb values may take some hours to drop post-haemorrhage. In extreme emergencies, uncross-matched group O blood may be needed but switch to group specific as soon as available. In pre-menopausal women only Rhesus negative blood should be used but Rhesus positive blood can be used in men and post menopausal women. If possible, ABO group specific blood should be given and preferably fully cross-matched blood (imposing delays of ~ 10 and 30 minutes respectively, not including transport times). Even in emergencies ensure correct patient identification, check the patient s wristband and complete the bag and tag for all transfused blood components. Fresh Frozen Plasma (discuss with Consultant Haematologist) Current red cell replacement is in the form of plasma-poor red cells, containing minimal coagulation factor activity. It is this coagulation factor deficiency which is the primary cause of coagulopathy after large volume blood transfusion. FFP is essentially plasma isolated by centrifugation of leucodepleted blood, and is thus rich in all clotting factors. It is, however, approximately five times more likely to cause a transfusion reaction than red cell concentrates. FFP should be given to those whose PT or APTT are 1.5 times normal, typically after x blood volume loss, and also in those with pre-existing deranged clotting e.g. secondary to liver disease. The adult dose is 12 15mls/kg units (approximately 4 units for an average adult). Allow 20 minutes for the FFP to be thawed in the laboratory. The appropriate component will be supplied by the laboratory but this may not be the same group as the patient. Occasionally it may be necessary to administer FFP before clotting results are available. This should be done in liaison with the Consultant Haematologist. It should, however, be ensured that an urgent sample has been sent for a coagulation screen to guide further management. Platelets (discuss with Consultant Haematologist) Allow margin of safety to ensure platelet count is maintained >50x10 9 / L in acutely bleeding patients 1,4. A platelet count of 50x10 9 / L may be anticipated when approximately x blood volume has been lost although there is marked individual variation. Platelets should be requested if it is anticipated that the count may fall below 50x10 9 / L and administered early to ensure the count is maintained above this critical level at all times. Platelets should be maintained >100x10 9 / L in patients with multiple and CNS trauma and those with impaired platelet function 4 (despite a normal platelet count) e.g. due to antiplatelet agents and uraemia. The adult dose is one pool and should preferably, but not necessarily, be ABO compatible. 4
5 One pool of platelets is stocked at Wishaw. Platelets are not stocked at Monklands and Hairmyres and usually need to come from the Blood Transfusion Centre at Gartnavel Hospital. A delay of at least 45 minutes is, therefore, expected and the need for platelets should be anticipated in advance to take this delay into account. Cryoprecipitate (discuss with Consultant Haematologist) High molecular weight proteins (fibrinogen, von Willebrand factor and factor VIII) are precipitated from plasma to form cryoprecipitate. Cryoprecipitate should be given when fibrinogen is below 1.0g/L despite administration of FFP which contains significant amounts of fibrinogen. Adult dose is 1.5 units / 10kg (approximately 2 pools). Each pool contains products from five donors with an associated increased risk of transfusion reactions. Consider Other Agents and Pre-existing Coagulation Disorders (discuss with Consultant Haematologist): Baseline coagulation screen and medical / drug history should suggest the possibility of a pre-existing coagulation disorder. Seek the advice of haematology staff and ensure coagulation screen is repeated regularly after intervention. Liver disease - Vitamin K (10mg in 1ml) should be administered as slow IV bolus in addition to blood products. Warfarin therapy - Guidelines are on the Lanarkshire Intranet 5 - Stop warfarin. Give 5mg Vitamin K as IV bolus. - Administer Prothrombin complex concentrate (Factors II, VII, IX and X.) - FFP can be used if Prothrombin complex concentrate is contraindicated. Heparin therapy - Stop heparin. - Give protamine as IV injection over 10 minutes. - 1mg protamine reverses units heparin. - Reduce protamine if >15 minutes after heparin infusion stopped. - Do not exceed a dose of 50mg protamine in a 10 minute period. - Caution with LMWH, which is not fully reversed by protamine. - Protamine side effects include hypotension. - Overdose of protamine sulphate may cause bleeding. Protamine has a weak anticoagulant effect due to an 5
6 interaction with platelets and with many proteins including fibrinogen. Post-thrombolysis - Stop thrombolysis. - Consider antifibrinolytics e.g. aprotinin and tranexamic acid. - Coagulation factors e.g. cryoprecipitate, may be required. Antiplatelet therapy - Stop infusion. Consider platelet transfusion. Haemophilia - Seek haematological advice. Recombinant Factor VIIa Recombinant factor VIIa is thought to cause a supra-physiological surge in thrombin generation on the surface of aggregated platelets, which is site specific and thus limited to areas of vessel damage 8. Its use in major haemorrhage, in the absence of haemophilia, is unlicensed and there is, as yet, only limited case reports to suggest it may be of benefit in this group of patients,6,7. The BCSH guidelines suggest it should be considered in diffuse coagulopathic bleeding with blood loss >300mls/hr where there is no heparin or warfarin effect, acidosis has been corrected and surgical intervention has failed to control haemorrhage 1. Major crush injury is a relative contra-indication as thrombotic sequelae may occur. The recommended dose is 90mcg / kg as an IV bolus over 2-5 minutes. Clinical signs indicating reduction in rate of haemorrhage should be sought. A further dose of 90mcg / kg can be considered after 2 hours if major blood loss persists. Liaison between responsible Consultant and Consultant Haematologist is required as currently rfviia is unlicensed. Suspect Disseminated Intravascular Coagulation (DIC) DIC is suggested by prolongation of PT and APTT, thrombocytopenia and a low or falling level of fibrinogen. It carries a high mortality and requires aggressive treatment with further FFP, platelets and cryoprecipitate 1. Prevention of DIC requires early, aggressive treatment of shock, hypoxia, acidosis and hypothermia. References 6
7 1. British Committee for Standards in Haematology. Guidelines on the management of massive blood loss. D Stainsby et al. British Journal of Haematology, 135: Alderson P, Schierhout G, et al. Colloids versus crystalloids for resuscitation in acutely ill patients. Cochrane Library, 2001; issue American Society of Anesthesiologists Task Force. Practice guidelines for blood component therapy. Anesthesiology, 1996; 84: Hoffman M, Dutton R, et al. Excessive bleeding in surgery and trauma. Surgical Rounds, 2002; 10: Management of over anticoagulation with warfarin NHS Lanarkshire intranet - Acute Division - Hospital - Policies and Procedures Clinical guidelines, policies and procedures - Haematology. 6. Perez F, et al. Successful treatment of intra-abdominal bleeding associated with DIC using rfviia. British Journal of Haematology, 2001; 114: Hedner U. NovoSeven as a universal haemostatic agent. Blood coagulation and Fibrinolysis, 2000; 11:
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 informationMajor 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 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 informationSign 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 informationJohn 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 informationMANAGEMENT OF BLEEDING AND EXCESSIVE ANTICOAGULATION IN ADULTS RECEIVING ANTI-COAGULANTS
Hairmyres Hospital MANAGEMENT OF BLEEDING AND EXCESSIVE ANTICOAGULATION IN ADULTS RECEIVING ANTI-COAGULANTS Bleeding in patients on anticoagulants, even in the absence of over-anticoagulation, can be life-threatening
More informationGuidelines for the management of warfarin reversal in adults
SharePoint Location Clinical Policies and Guidelines SharePoint Index Directory General Policies and Guidelines Sub Area Haematology and Transfusion Key words (for search purposes) Warfarin, Bleeding Central
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 informationGuidance 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 informationEMSS17: 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 informationBleeding, 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 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 informationUnless this copy has been taken directly from the Trust intranet site (Pandora) there is no assurance that this is the most up to date version
Policy No: RM57 Version: 5.0 Name of Policy: Management of Massive Blood Transfusion Effective From: 02/03/2018 Date Ratified 11/10/2017 Ratified Hospital Transfusion Committee Review Date 01/10/2019 Sponsor
More informationMANAGEMENT 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 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 informationProthrombin Complex Concentrate- Octaplex. Octaplex
Prothrombin Complex Concentrate- Concentrated Factors Prothrombin Complex Concentrate (PCC) 3- factor (factor II, IX, X) 4-factor (factors II, VII, IX, X) Activated 4-factor (factors II, VIIa, IX, X) Coagulation
More informationActive date July Ratification date: Review date January 2014 Applies to: Staff managing patients on warfarin. Exclusions:
Guideline Title: Guidelines for the management of warfarin reversal [key words : Beriplex, Octaplex, PCC, vitamin K, anticoagulant, anticoagulation] Authors: Dr Sarah Allford, Consultant Haematologist
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 informationGUIDELINES 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 informationLEEDS TEACHING HOSPITALS TRUST. Transfusion in massive haemorrhage in Neonates & Paediatrics (birth -16years) Guideline Detail
LEEDS TEACHING HOSPITALS TRUST Transfusion in massive haemorrhage in Neonates & Paediatrics (birth -16years) Guideline Detail Ownership Fran Hartley, Transfusion Practitioner (contact for review) Dr Marina
More informationDOCUMENT CONTROL PAGE
DOCUMENT CONTROL PAGE Title Title: UNDERGOING SPINAL DEFORMITY SURGERY Version: 2 Reference Number: Supersedes Supersedes: all other versions Description of Amendment(s): Revision of analgesia requirements
More informationWhat s in the Massive Transfusion Protocol (MTP) Package?
What s in the Massive Transfusion Protocol (MTP) Package? The Massive Transfusion Protocol Package is a set of documents intended to improve the coordination of a Massive Transfusion Protocol. The kit
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 informationPathophysiologie und Therapie bei Massenblutung
Swisstransfusion Bern, 7. September 2012 Pathophysiologie und Therapie bei Massenblutung Lorenzo ALBERIO Universitätsklinik für Hämatologie und Hämatologisches Zentrallabor Coagulopathy of Trauma Haemorrhage
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 informationDr 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 informationMANAGEMENT OF OVERANTICOAGULATION AND PREOPERATIVE MANAGEMENT OF WARFARIN DOSE 1. GUIDELINES FOR THE MANAGEMENT OF AN ELEVATED INR
MANAGEMENT OF OVERANTICOAGULATION AND PREOPERATIVE MANAGEMENT OF WARFARIN DOSE 1. GUIDELINES FOR THE MANAGEMENT OF AN ELEVATED INR 1.1 Time to lower INR Prothrombinex-VF - 15 minutes Fresh Frozen Plasma
More informationANTICOAGULATION RELATED BLEEDING - GUIDELINE SUMMARY
ANTICOAGULATION RELATED BLEEDING - GUIDELINE SUMMARY Click here for the full Thrombosis Prevention Investigation and Management of Anticoagulation Guideline Click on the appropriate link below: o START
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 informationanesthesia & mass casualty events
anesthesia & mass casualty events marc p steurer, md, desa president, trauma anesthesiology society (www.tashq.org) director, trauma anesthesiology UCSF/ SFGH associate professor UCSF faculty disclosure
More informationMassive 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 informationMy 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 informationAdult Reversal of Anticoagulation and Anti-platelet Agents for Life- Threatening Bleeding or Emergency Surgery Protocol
Adult Reversal of Anticoagulation and Anti-platelet Agents for Life- Threatening Bleeding or Emergency Surgery Protocol Page Platelet Inhibitors 2 Aspirin, Clopidogrel (Plavix), Prasugrel (Effient) & Ticagrelor
More informationUse 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 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 informationBLEEDING DISORDERS Simple complement:
BLEEDING DISORDERS Simple complement: 1. Select the statement that describe the thrombocytopenia definition: A. Marked decrease of the Von Willebrandt factor B. Absence of antihemophilic factor A C. Disorder
More informationApproach 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 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 informationGUIDELINES FOR MANAGEMENT OF OVER ANTICOAGULATION WITH WARFARIN
GUIDELINES FOR MANAGEMENT OF OVER ANTICOAGULATION WITH WARFARIN Version Date Purpose of Issue/Description of Change Review Date 1 29/11/05 New Policy December 2007 2 Oct 07 Review Oct 09 3 March 10 Review
More informationBlood transfusion and the anaesthetist: management of massive haemorrhage
doi:10.1111/j.1365-2044.2010.06538.x GUIDELINES Blood transfusion and the anaesthetist: management of massive haemorrhage Association of Anaesthetists of Great Britain and Ireland Membership of the Working
More informationCOMMENTARY. Management of massive blood loss: a template guideline
British Journal of Anaesthesia 85 (3): 487±91 (2000) Management of massive blood loss: a template guideline D. Stainsby 1, S. MacLennan 2 and P. J. Hamilton 3 1 National Blood Service Newcastle Centre,
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 informationBlood products and plasma substitutes
Blood products and plasma substitutes Plasma substitutes Dextran 70 and polygeline are macromolecular substances which are metabolized slowly; they may be used to expand and maintain blood volume in shock
More information*Corresponding author: Key words: neurotrauma, coagulopathy
COAGULOPATHY IN NEURO TRAUMA A PROSPECTIVE ANALYSIS OF THE INCIDENCE AND CAUSES OF COAGULOPATHY IN PATIENTS WITH PURE NEURO TRAUMA AND MIXED TRAUMA ADMITTED TO THE NATIONAL HOSPITAL SRI LANKA *Jayawickrama
More informationthe 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 informationThe 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 informationUnrestricted. 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 informationBlood transfusion. General surgery department of SGMU Lecturer ass. Khilgiyaev R.H.
Blood transfusion General surgery department of SGMU Sources of blood Donors Own blood of patient (autoreinfusion): autoreinfusion of blood from cavities (haemotorax, haemoperitoneum) in case of acute
More informationBassett Medical Center The Mary Imogene Bassett Hospital Clinical Laboratory Blood Bank Title: MTP 2016 Revision: 2.00 Created By: Admin, The Last
Bassett Medical Center The Mary Imogene Bassett Hospital Clinical Laboratory Blood Bank Title: MTP 2016 Revision: 2.00 Created By: Admin, The Last Approved Time: 7/22/2016 12:44:54 PM Massive Transfusion
More informationChapter 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 informationPrinted copies of this document may not be up to date, obtain the most recent version from
Children s Acute Transport Service Clinical Guidelines Septic Shock Document Control Information Author Claire Fraser P.Ramnarayan Author Position tanp CATS Consultant Document Owner E. Polke Document
More informationMASSIVE HAEMORRHAGE POLICY. ABMU HB Transfusion Team
MASSIVE HAEMORRHAGE POLICY ABMU HB Transfusion Team Objec@ves To define the responsibili@es and roles of the Clinical team and the Haematology Department in the management of MASSIVE HAEMORRHAGE To describe
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 informationGuidelines for Shared Care Centres and Community Staff
Reference: CG1410 Written by: Dr Jeanette Payne Peer reviewer Dr Jenny Welch Approved: February 2016 Approved by D&TC: 8th January 2016 Review Due: February 2019 Intended Audience This document contains
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 informationMassive Transfusion in Trauma
Page 1 Massive Transfusion in Trauma Robert S. Harris, M.D. Atlanta, Georgia Definitions and Demographics Hemorrhage is the second most common cause of death following injury and trauma, and is responsible
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 informationDate 29 th March 2018 Our Ref FA_Anticoag/MGPG/Mar18 Enquiries to Frances Adamson Extension Direct Line tadamson(anhs.
NHS Grampian Westholme Woodend Hospital Queens Road ABERDEEN AB15 6LS NHS Grampian Date 29 th March 2018 Our Ref FA_Anticoag/MGPG/Mar18 Enquiries to Frances Adamson Extension 56689 Direct Line 01224 556689
More informationPediatric massive transfusion protocols
University of New Mexico UNM Digital Repository Emergency Medicine Research and Scholarship Emergency Medicine 2014 Pediatric massive transfusion protocols Ramsey Tate Follow this and additional works
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 informationManagement of the Trauma Patient. Elizabeth R Benjamin MD PhD Trauma and Surgical Critical Care Critical Care Symposium April 20, 2015
Management of the Trauma Patient Elizabeth R Benjamin MD PhD Trauma and Surgical Critical Care Critical Care Symposium April 20, 2015 Saturday Night 25 yo M s/p high speed MVC Hypotensive in the ED, altered
More informationEffective 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 informationMANAGEMENT OF COMMON BLEEDING DISORDERS. Auro Viswabandya Department of Haematology, CMC, Vellore
MANAGEMENT OF COMMON BLEEDING DISORDERS Auro Viswabandya Department of Haematology, CMC, Vellore BLOOD CLOT : PRIMARY HAEMOSTASIS (Platelets) + SECONDARY HAEMOSTASIS (Coagulation Factors) HAEMOSTATIC DISORDERS
More informationADMINISTRATIVE CLINICAL Page 1 of 6
ADMINISTRATIVE CLINICAL Page 1 of 6 Anticoagulant Guidelines #2: REVERSAL OF OR MANAGEMENT OF BLEEDING WITH ANTICOAGULANTS Origination Date: Revision Date: Reviewed Date: 09/12 09/12, 01/13, 11/13, 11/15
More informationCrackCast Episode 7 Blood and Blood Components
CrackCast Episode 7 Blood and Blood Components Episode Overview: 1) Describe the 3 categories of blood antigens 2) Who is the universal donor and why? 3) Define massive transfusion 4) List 5 physiologic
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 informationPACKAGE LEAFLET: INFORMATION FOR THE USER. octaplaslg mg/ml solution for infusion Human plasma proteins
PACKAGE LEAFLET: INFORMATION FOR THE USER octaplaslg 45-70 mg/ml solution for infusion Human plasma proteins Read all of this leaflet carefully before you start using this medicine. - Keep this leaflet.
More informationSAFE approach. Unresponsive? Shout or call for help. Open Airway. Not Breathing normally? 30 chest compressions. 2 rescue breaths
Basic Life Support Dial 2222 Chin lift, head tilt jaw thrust Look, listen, feel For 10 seconds Rate 100/min *Lateral tilt* SAFE approach Unresponsive? Shout or call for help Open Airway Not Breathing normally?
More informationTRAUMA RESUSCITATION. Dr. Carlos Palisi Dr. Nicholas Smith Liverpool Hospital
TRAUMA RESUSCITATION Dr. Carlos Palisi Dr. Nicholas Smith Liverpool Hospital First Principles.ATLS/EMST A- Airway and C-spine B- Breathing C- Circulation and Access D- Neurological deficit E- adequate
More informationBlood Transfusion in Obstetrics
Blood Transfusion in Obstetrics Nigam A, 1 Prakash A, 2 Saxena P 1 1 Department of Gynecology and Obstetrics 2 Department of Medicine Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New
More informationEffect of under filling tube
Effect of under filling tube 2 What constitutes underfilling? A 4.5ml vacutainer collection tube should contain at least 4ml of blood Less than that could give falsely prolonged clotting times ALSO be
More informationPatient Blood Management Guidelines: Module 1. Critical Bleeding Massive Transfusion
Patient Blood Management Guidelines: Module 1 Critical Bleeding Massive Transfusion National Blood Authority, 2011. With the exception of any logos and registered trademarks, and where otherwise noted,
More informationBritish 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 informationGUIDANCE DOCUMENT FOR MASSIVE HEMORRHAGE MANAGEMENT IN ADULTS
GUIDANCE DOCUMENT FOR MASSIVE HEMORRHAGE MANAGEMENT IN ADULTS 1.0 Definitions & Acronyms 1.1 Massive Hemorrhage Event (MHE): Transfusion of a volume of blood components equivalent to a patient s estimated
More informationReversal of Anticoagulants at UCDMC
Reversal of Anticoagulants at UCDMC Introduction: Bleeding complications are a common concern with the use of anticoagulant agents. In selected situations, reversing or neutralizing the effects of an anticoagulant
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 informationNottingham Neonatal Service Clinical Guidelines
ottingham eonatal Service Clinical Guidelines eonatal Haemostasis Full Title of Guideline: eonatal Haemostasis Dr C Young Consultant eonatologist, Dr D Jayasinghe Consultant eonatologist, Author (include
More informationNon-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 informationMASSIVE TRANSFUSION PROTOCOL
MASSIVE TRANSFUSION PROTOCOL IF YOU ANTICIPATE EMERGENT NEED FOR LARGE AMOUNTS OF BLOOD IN A SHORT PERIOD OF TIME Call Blood Bank: 6622121 Tell them you have a patient who needs a Massive Transfusion and
More informationPREDLOG SMERNIC ZA KLINIČNO UPORABE SVEŽE ZMRZNJENE PLAZME Guidelines for clinical use of FFP proposal
PREDLOG SMERNIC ZA KLINIČNO UPORABE SVEŽE ZMRZNJENE PLAZME Guidelines for clinical use of FFP proposal Dragoslav Domanovič, MD. PhD. Blood transfusion centre of Slovenia, Ljubljana FFP - definition Fresh
More informationBLOOD TRANSFUSION. Dr Lumka Ntabeni
BLOOD TRANSFUSION Dr Lumka Ntabeni Blood transfusion definition SAFE transfer of BLOOD COMPONENTS from a DONOR to a RECEPIENT CONTENT Brief history of blood transfusion How is safety guaranteed? How do
More informationUnit 5: Blood Transfusion
Unit 5: Blood Transfusion Blood transfusion (BT) therapy: Involves transfusing whole blood or blood components (specific portion or fraction of blood lacking in patient). Learn the concepts behind blood
More informationUse of Prothrombin Complex Concentrates (PCC) CONTENTS
CONTENTS Page 1: Exclusion Criteria and Approved Indications for Use Page 2: Dosing / Administration / Storage Page 4: Prescribing / Monitoring / Dispensing Page 5: Cautions / Warnings / Cost Analysis
More informationAppendix 2H - SECONDARY CARE CONVERSION GUIDELINES ORAL ANTICOAGULANTS
Appendix 2H - SECONDARY CARE CONVERSION GUIDELINES ORAL ANTICOAGULANTS Please note that newer oral anticoagulants e.g. rivaroxaban, dabigatran and apixiban should be only be considered in patients with
More informationHematology Review. CCRN exam. The Coagulation Cascade. The Coagulation Cascade. Components include: Intrinsic pathway Extrinsic pathway Common pathway
CCRN exam Hematology Review CCRN Review October 2013 Department of Critical Care Nursing Hematology is 2% of the exam Focus on coagulation cascade, DIC, and HIT Anatomy of the hematologic system Bone marrow
More informationConsensus Statement for Management of Anticoagulants and Antiplatelet drugs in Patients with Hip Fracture
Consensus Statement for Management of Anticoagulants and Antiplatelet drugs in Patients with Hip Fracture Patients with hip fractures should be operated on within 36 hours of presentation wherever possible.
More informationManagement of Massive Blood Loss
Asuccessful outcome requires prompt action and good communication between clinical specialties, diagnostic laboratories, hospital transfusion laboratory staff and the Blood Service. Therapeutic goals These
More informationA 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 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 informationADVOCATE HEALTHCARE GUIDELINE FOR ANTITHROMBOTIC REVERSAL
Minimal clinical evidence exists to support the efficacy of nonspecific procoagulant therapies that promote thrombin formation and antifibrinolytics in the setting of antithrombotic-related bleeding. Hemostatic
More informationPrinted copies of this document may not be up to date, obtain the most recent version from
Children s Acute Transport Service Clinical Guidelines Septic Shock Document Control Information Author Shruti Dholakia L Chigaru Author Position Fellow CATS Consultant Document Owner E. Polke Document
More informationWhen Should I Use Tranexamic Acid for Children? Dr Andrea Kelleher Consultant Adult and Paediatric Cardiac Anaesthetist
When Should I Use Tranexamic Acid for Children? Dr Andrea Kelleher Consultant Adult and Paediatric Cardiac Anaesthetist When? When a drug is licenced for (the proposed) use When its use is supported by
More informationAgent Dose MoA/PK/Admin Adverse events Disadvantages Protamine Heparin: 1mg neutralizes ~ 100 units Heparin neutralization in ~ 5 min
Nanik (Nayri) Hatsakorzian Pharm.D/MPH candidate 2014 Touro University College of Pharmacy CA Bleeding Reversal Agents Agent Dose MoA/PK/Admin Adverse events Disadvantages Protamine Heparin: 1mg neutralizes
More informationEarly 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.. Transfusion / resuscitation Anticoagulants new and old..
More informationIntraoperative 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 informationShock and Resuscitation: Part II. Patrick M Reilly MD FACS Professor of Surgery
Shock and Resuscitation: Part II Patrick M Reilly MD FACS Professor of Surgery Trauma Patient 1823 / 18 Police Dropoff Torso GSW Lower Midline / Right Buttock Shock This Monday Trauma Patient 1823 / 18
More informationGUIDELINE: ASSESSMENT OF BRUISING & BLEEDING IN CHILDREN. All children in whom there is concern regarding bruising / bleeding
GUIDELINE: ASSESSMENT OF BRUISING & BLEEDING IN CHILDREN Reference: Bruising / Bleeding / NAI Version No: 1 Applicable to All children in whom there is concern regarding bruising / bleeding Classification
More informationAnticoagulants. Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT
Haemostasis Thrombosis Phases Endogenous anticoagulants Stopping blood loss Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT Vascular Platelet
More informationChapter 1 The Reversing Agents
Available Strategies to Reverse Anticoagulant Medications Michael L. Smith, Pharm. D., BCPS, CACP East Region Pharmacy Clinical Manager Hartford HealthCare Objectives: Describe the pharmacological agents
More informationBlood 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