Transfusion Medicine TICU-1

Transfusion Medicine TICU-1 - Tranfusion Medicine Amanda J....

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Tranfusion Medicine Amanda J. Wheeler, MD Trauma/Critical Care Stanford University Medical Center May 7, 2007
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Tranfusion Medicine “The 1988 NIH Consensus Conference on Perioperative Red Blood Cell Transfusions suggested that no single criterion should be used as an indication for red cell component therapy and that multiple factors related to the patient's clinical status and oxygen delivery needs should be considered.”
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Transfusion Triggers/Indications: Acute Blood Loss Crystalloids should be used to fluid resuscitate hypovolemic patients along with inotropic agents to maintain blood pressure and cardiac output. Oxygen delivery adequate because greater cardiac output, rightward shift of the oxygen-hemoglobin dissociation curve, and increased oxygen extraction can compensate for the decrease in arterial oxygen content. Need for transfusion based on rate of blood loss. >40% blood volume loss has been shown to require rapid transfusion as well as 30-40% loss after initial replacement with crystalloids.
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Hemoglobin Concentration Hgb around 10 previously used as a trigger. Studies reviewing Jehovah’s Witnesses postop outcomes have shown that lower Hgb concentrations did not increase mortality. Animal models and retrospective studies have shown increased mortality at Hgb levels of 3.5-4.0g/dl. Notably, increase in the Lactate levels and the oxygen extraction ratio >50% were observed. However in animal models with cardiac disease, the increase in mortality was observed around Hgb levels of 6-7.5 g/dl. Canadian Critical Care Trial Group: study compared “restrictive” (Hgb<7) to “liberal” (Hgb<10) transfusion strategies among critically ill patients. The “restrictive” strategy was as effective and superior to the “liberal” transfusion strategy among patients less than 55 and without cardiac disease. Patients had an overall greater decrease in mortality and less complications. They concluded that a transfusion threshold of 7 g/dl is safe in critically ill patients, including those with minimal cardiopulmonary disease. Recent recommendations suggest RBC transfusion only in cases with <Hgb and known clinical
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Blood Transfusion Protocol at Stanford Surgery ICU Committee: Susan Brundage, MD, MPH, Myriam Curet, MD, Rochelle Dicker, MD, Ralph Greco, MD , David Gregg, MD, John Morton, MD, MPH, Tom C. Nguyen, MD, MPH, Jeffrey Norton, MD, Andrew Shelton, MD, David Spain, MD, Mark Welton, MD, M. Lance Tavana, MS4. Background:
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This note was uploaded on 12/21/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Transfusion Medicine TICU-1 - Tranfusion Medicine Amanda J....

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