marcqi_blood_transfusion.pdfUNDERSTAND WORD FEATURE
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This document discusses strategies to reduce blood transfusions for patients undergoing hip and knee arthroplasty. It provides evidence that restrictive transfusion protocols with a threshold of 8 g/dL are safe based on multiple studies. Transfusions are associated with increased risks of infection, mortality and costs. The document reviews transfusion rates among MARCQI sites and recommends adoption of restrictive guidelines and use of tranexamic acid to reduce transfusions when possible.
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Introduction:
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Objectives:
Understand the indications and types of blood and blood components.
Learn the step-by-step process of blood request and retrieval.
Identify the roles and responsibilities of medical and paramedical staff.
Recognize safety checks and documentation required.
Understand storage, transport, and administration protocols.
Learn how to handle adverse transfusion reactions.
Basics of Blood Components:
Whole Blood
Packed Red Blood Cells (PRBCs)
Platelets
Fresh Frozen Plasma (FFP)
Cryoprecipitate
Each component serves a specific clinical need (e.g., PRBCs for anemia, platelets for thrombocytopenia, FFP for coagulation disorders).
Pre-transfusion Protocol:
Clinical Indication:
Assess patients clinical need and hemoglobin/platelet/coagulation status.
Use evidence-based transfusion thresholds (e.g., Hb < 7 g/dL in stable patients).
Transfusion Consent:
Informed consent must be obtained explaining risks, benefits, and alternatives.
Sample Collection:
Label correctly with patients full name, ID, date, and time.
Blood grouping and crossmatch samples must be sent according to guidelines.
Requisition Form:
Must include patient details, indication, type/number of units requested, urgency.
Blood Bank Process:
Verification:
Patient identity and sample labeling verified.
Grouping, crossmatching, antibody screening performed.
Issue of Blood:
Units matched and labeled with recipient info.
Compatibility label and documentation provided.
Retrieval Protocol:
Authorized Personnel:
Only trained staff with valid ID are allowed to collect blood products.
Blood Transport Container:
Use validated transport boxes with ice packs/cold chain for red cells.
Platelets transported at room temperature.
Documentation and Verification:
Confirm patient identity, blood component, unit number, expiry date.
Sign handover forms at the blood bank and upon delivery.
Timeliness:
Minimize delay between issue and transfusion (within 30 minutes for PRBC).
Return unused units if not used within 30 minutes.
At the Bedside:
Final Identity Check:
Verify patient's ID band with blood bag label.
Double-check by two healthcare personnel.
Baseline Observations:
Temperature, BP, HR, SpO prior to starting transfusion.
Transfusion Monitoring:
Monitor vitals every 15 minutes initially, then hourly.
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This document discusses guidelines for single unit red blood cell transfusions based on Patient Blood Management Guidelines. It provides 3 key reasons why excessive transfusion is problematic: 1) each transfusion increases the risk of nosocomial infection and other morbidities, 2) higher transfusion requirements are associated with more clinical complications, and 3) transfusion associated circulatory overload is a high risk adverse effect. The document emphasizes transfusing one unit at a time and reassessing the patient before additional units, in order to follow a more restrictive approach and reduce risks whenever possible based on the patient's clinical status rather than hemoglobin levels alone.Final ppt.pptx- perioperative blood transfusion guidelines
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Introduction:
Blood transfusion is a life-saving intervention that plays a vital role in modern medicine. Whether in trauma, surgery, anemia, or oncology, the safe retrieval and transfusion of blood components is essential. Errors during retrieval, transport, or administration can lead to serious complications, including hemolytic reactions or death. This presentation aims to provide a comprehensive guide to the protocol involved in retrieving blood products from the blood bank and ensuring their safe and effective transfusion. It focuses on procedural accuracy, interdepartmental coordination, regulatory compliance, and patient safety.
Objectives:
Understand the indications and types of blood and blood components.
Learn the step-by-step process of blood request and retrieval.
Identify the roles and responsibilities of medical and paramedical staff.
Recognize safety checks and documentation required.
Understand storage, transport, and administration protocols.
Learn how to handle adverse transfusion reactions.
Basics of Blood Components:
Whole Blood
Packed Red Blood Cells (PRBCs)
Platelets
Fresh Frozen Plasma (FFP)
Cryoprecipitate
Each component serves a specific clinical need (e.g., PRBCs for anemia, platelets for thrombocytopenia, FFP for coagulation disorders).
Pre-transfusion Protocol:
Clinical Indication:
Assess patients clinical need and hemoglobin/platelet/coagulation status.
Use evidence-based transfusion thresholds (e.g., Hb < 7 g/dL in stable patients).
Transfusion Consent:
Informed consent must be obtained explaining risks, benefits, and alternatives.
Sample Collection:
Label correctly with patients full name, ID, date, and time.
Blood grouping and crossmatch samples must be sent according to guidelines.
Requisition Form:
Must include patient details, indication, type/number of units requested, urgency.
Blood Bank Process:
Verification:
Patient identity and sample labeling verified.
Grouping, crossmatching, antibody screening performed.
Issue of Blood:
Units matched and labeled with recipient info.
Compatibility label and documentation provided.
Retrieval Protocol:
Authorized Personnel:
Only trained staff with valid ID are allowed to collect blood products.
Blood Transport Container:
Use validated transport boxes with ice packs/cold chain for red cells.
Platelets transported at room temperature.
Documentation and Verification:
Confirm patient identity, blood component, unit number, expiry date.
Sign handover forms at the blood bank and upon delivery.
Timeliness:
Minimize delay between issue and transfusion (within 30 minutes for PRBC).
Return unused units if not used within 30 minutes.
At the Bedside:
Final Identity Check:
Verify patient's ID band with blood bag label.
Double-check by two healthcare personnel.
Baseline Observations:
Temperature, BP, HR, SpO prior to starting transfusion.
Transfusion Monitoring:
Monitor vitals every 15 minutes initially, then hourly.
Patient Blood Management
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油
This document discusses patient blood management (PBM), which is a multidisciplinary approach to optimizing patient care and reducing unnecessary blood transfusions. It has three pillars: optimizing erythropoiesis, minimizing bleeding, and harnessing physiological reserves of anemia. The evidence shows PBM can reduce transfusions by 39% without increasing risks. It has led to reduced transfusions and costs in various settings like cardiac and orthopedic surgery. PBM programs require a multidisciplinary team approach led by specialties like anesthesiology. Overall, PBM provides better patient outcomes while reducing allogeneic blood use.Transfusion therapy
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油
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The document discusses a study comparing restrictive versus liberal blood transfusion strategies in critically ill patients, focusing on their impact on 30-day all-cause mortality. It reveals that a restrictive strategy (maintaining hemoglobin levels of 7-9 g/dL) resulted in reduced transfusion requirements and did not increase mortality compared to a liberal strategy (maintaining levels of 10-12 g/dL). The findings suggest that a restrictive transfusion approach may be equally effective or superior in specific patient subsets, challenging previous beliefs about transfusion thresholds.INTRODUCCIN AL PATIENT BLOOD MANAGEMENT. Conferencia Inagural. Prof Herrera
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The document summarizes the findings of several clinical trials (TRICC, TRISS, REALITY, FOCUS, TRICS 3, MINT) that compared restrictive versus liberal transfusion strategies in different patient populations, including critically ill patients, patients with septic shock, patients undergoing cardiac or hip surgery, and patients with acute myocardial infarction and anemia. The trials generally found no significant differences in mortality between restrictive and liberal strategies, suggesting it is reasonable and safe to use restrictive transfusion thresholds in most cases to avoid unnecessary transfusions and their associated risks. However, the optimal strategy remains unclear for some subgroups like patients with acute coronary syndromes.Why give 2 when 1 will do final
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油
This document discusses guidelines for single unit red blood cell transfusions based on Patient Blood Management Guidelines. It provides 3 key reasons why excessive transfusion is problematic: 1) each transfusion increases the risk of nosocomial infection and other morbidities, 2) higher transfusion requirements are associated with more clinical complications, and 3) transfusion associated circulatory overload is a high risk adverse effect. The document emphasizes transfusing one unit at a time and reassessing the patient before additional units, in order to follow a more restrictive approach and reduce risks whenever possible based on the patient's clinical status rather than hemoglobin levels alone.Final ppt.pptx- perioperative blood transfusion guidelines
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油
This document discusses guidelines for single unit red blood cell transfusions based on Patient Blood Management Guidelines. It provides background on the guidelines, including that they were introduced to improve outcomes by avoiding unnecessary exposure to blood components. The document discusses reasons for a restrictive transfusion approach using single units, including that transfusion is associated with increased risks in a dose-dependent manner. It recommends transfusing one unit at a time and reassessing the patient's symptoms before providing additional units.PATIENT BLOOD MANAGEMENT Dr Garcia Erce Mediterranean Anaemia Course4th cong...
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marcqi_blood_transfusion.pdfUNDERSTAND WORD FEATURE
- 1. Blood Transfusion Project Reducing Transfusion in the MARCQI Population
- 2. Anemia in Healthy Awake Volunteers Critical hemoglobin threshold unknown in humans At 6 g/dL Decline in cognitive function At 5 g/dL VO2 maintained ST changes in 5% Memory formation impaired Lieberman, et al. Anesthesiology 2000
- 3. Risks of Blood Transfusion Viral transmission Acute transfusion reactions Immunosuppression Acute inflammatory response Noninfectious Hazards Immunosuppression Infection
- 4. Age of Stored Blood Hovav et al. Transfusion. 1999; 39: 277-281.
- 5. Williamson LM, et al. BMJ. 1999;319:16-9. Serious Hazards of Transfusion Based on 366 spontaneously-reported deaths/major complications between October 1996 and September 1998 in the UK and Ireland. Transfusion-transmitted infections Acute lung injury Post-transfusion purpura Graft vs host disease Delayed transfusion reaction Acute transfusion reaction Incorrect blood/ component transfused 3% 6% 8% 2% 14% 15% 53%
- 6. Immune Effects of Blood Decreased T-cell proliferation Decreased CD3, CD4, CD8 T-cells Increased Cell-mediated lympholysis Increased TNF-alpha Increased suppressor T-cell activity Reduced natural killer cell activity McAlister FA, et al, British Journal of Surgery 1998; 85: 171-178 Innerhofer et al. Transfusion 1999 Oct;39(10):1089 TRIM Transfusion-associated Immunomodulation
- 7. Blood Transfusion Increases Risk of Postoperative Bacterial Infection 20 peer-reviewed studies, 1986-2000 13,152 patients 5215 transfused 7937 not transfused Association of Transfusion to Infection OR 3.45 (range 1.43-15.15) 17 of 20 studies with p < 0.05 Hill GE, Minei JP et al. J Trauma 2003;54:908-914
- 8. Predictors and Complications of Blood Transfusion in Total Hip and Knee Arthroplasty Henry Ford Hospital Jan 2011 to Dec 2012 1573 patients 13.3% higher infection rate in transfused patients Factors associated with transfusion Age Female gender BMI Frisch, et al. AAHKS 11/2013
- 9. The TRICC Study Herbert PC, et al. NEJM 1999 838 patients ICU patients Placed into one of two groups Restrictive group: Transfuse if Hb < 7 Maintain between 7 and 9 Liberal group: Transfuse if Hb < 10 Maintain between 10 and 12 The primary outcome measure was death from all causes in the 30 days after randomization
- 10. The TRICC Study 8.7% vs 16.1% 5.7% vs 13.0% Herbert PC, et al. NEJM 1999
- 11. CRIT Study 4,892 ICU patients in the US Prospective, multiple center, observational cohort Examine the relationship of Anemia RBC transfusion Clinical outcomes Crit Care Med. 2004 Jan;32(1):39-52
- 12. CRIT Results 35% of Blood transfused in patients with Hgb 9 Crit Care Med. 2004 Jan;32(1):39-52
- 13. CRIT Results RBC transfusion was independently associated with higher mortality OR 1.65 (CI 1.35-2.03) OR 2.62 if 3-4 units transfused Crit Care Med. 2004 Jan;32(1):39-52
- 14. 0 1 2 3-5 6 Ann Thorac Surg 2006;81:1650 7
- 15. FOCUS Trial Inclusion criteria: Undergo surgery for hip fracture Have a history of cardiovascular disease Have a postoperative Hgb < 10 g/dL Randomized to keep Hgb > 10 g/dL or not Primary outcome Ability to walk 10 feet without assistance at 60 days Negative outcomes Postoperative unstable angina Myocardial infarction Death
- 16. N Engl J Med 2011;365:2453-62.
- 17. Financial Burden $11.08 $10.76 $12.56 $12.56 $14.97 $0 $5 $10 $15 $20 FY'04 FY'05 FY'06 FY'07 FY'08 UMHHC direct cost of blood products Millions
- 18. Exploring Surgery Level Risk Factors for Transfusion and Readmission
- 19. General versus regional anesthesia Hip Knee
- 20. Time in OR by hospital Hip Knee Minutes Hospital Hospital
- 21. Use of Tranexemic Acid Hip Knee
- 22. Associations of surgical variables with outcome for hip arthroplasty Variable Blood Transfusion Readmission RR (95% CI) RR (95% CI) Anesthesia General versus Regional 1.30 (0.921.86) 1.53 (1.181.97) Operative Approach Anterolateral versus Posterior 1.52 (1.211.90) # 0.88 (0.671.14) Anterior versus Posterior 0.82 (0.302.23) 1.22 (0.761.96) Tranexemic Acid 0.64 (0.440.93) 1.10 (0.931.29) 15 Minutes of OR time 1.04 (0.971.11) Blood Transfusion 1.20 (1.091.33) # Interpret with caution
- 23. Associations of surgical variables with outcome for knee arthroplasty Variable Blood Transfusion Readmission RR (95% CI) RR (95% CI) Anesthesia General versus Regional 1.38(1.031.84) 1.15 (0.831.61) Operative Approach MPK vs SVK 1.12 (0.801.59) 1.02 (0.871.20) MVK vs SVK 0.79 (0.611.02) 1.01 (0.871.17) Tranexemic Acid 0.85 (0.581.25) 0.90 (0.721.11) 15 Minutes of OR time 1.11 (1.071.16) Blood Transfusion 1.27 (1.081.50)
- 24. Crude and adjusted risk of blood transfusion for hip arthroplasty by MARCQI site Rate of Transfusion Hospital
- 25. Crude and adjusted risk of blood transfusion for knee arthroplasty by MARCQI site Rate of Transfusion Hospital
- 26. Allogenic Transfusion Risks Disease transmission Increased complication rates Increased readmissions (MARCQI data) Increased mortality
- 27. MARCQI Transfusion Data 9.8% of MARCQI patients are transfused 14.2% of hips 7% of knees 23% of bilateral knees Only 1.5% of patients have nadir Hgb < 7 g/dL 4.6% receive TXA
- 28. MARCQI Sites: Transfusion Guidelines Wide range of transfusion triggers Some have no protocol Asymptomatic patient Hgb < 7 g/dL to Hgb < 9 g/dL Symptomatic patients Hgb < 7 g/dL to Hgb < 11 g/dL
- 29. U of M Transfusion Guidelines Hgb < 6 g/dL in asymptomatic patient Hbg < 7 g/dL in post-op or ill patient Hgb < 10 g/dL acute coronary syndrome
- 30. Restrictive Transfusion Protocols Are safe Recommended by: American Red Cross (ARC) American Association of Blood Banks (AABB) Cochrane Collaboration Review
- 31. Summary Transfusion may benefit patients during acute coronary syndromes if Hgb < 8-10 g/dL There is very rarely an indication to transfuse ANY patient with a Hbg 10 g/dL Each unit incrementally increases risk Decreasing transfusion may reduce risk of infection and readmission reduce mortality decrease cost
- 32. Guidelines for Blood Transfusion: PRBCs These guidelines are intended to ensure that the most appropriate, efficient and safe use of the blood supply is achieved To establish evidence-based criteria for the transfusion of blood components Every indication for the use of blood products cannot be anticipated These guidelines are not intended to override physician judgement
- 33. Guidelines for Blood Transfusion: PRBCs Administered as single units except for ongoing blood loss with hemodynamic instability. Transfusion decisions are clinical judgments that should not be based on laboratory parameters alone.
- 34. Transfusion Guidelines Red Cross Transfusion Guidelines Post-operative patients Indications for allogenic transfusion Threshold of Hgb < 8 g/dL Clinically significant symptoms of anemia Unresponsive to fluid resuscitation Clinical judgement in patients with Hgb < 10 g/dL and increased risk factors
- 35. MARCQI recommendation Encourage adoption of the Red Cross Guidelines or similar protocols at your institution and in your practice Transfuse one unit at a time Encourage these practices with your colleagues
- 36. Tranexamic Acid Low numbers in MARCQI Associated with reduced transfusion in hips Concerns over risks Increasing support in literature Will continue to monitor