Clinical transfusion: surgery and critical illness

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Clinical transfusion: surgery and critical illness

Good blood management

Who are the patients who are transfused?

Medical or surgical?

Transfusion in major haemorrhage

Planned surgery

Blood use varies widely for very similar operations

Preoperative management

Anaemia

Management of iron deficiency anaemia

Bleeding problems

History

Abnormal coagulation screen

Low platelet count

Patients on anticoagulants and antiplatelet agents

Preoperative autologous blood donation

Acute normovolaemic haemodilution

Intra- and post-operative management

Thresholds for red cell transfusion in surgery and critical

Intra- and post-operative blood conservation

Post-operative anaemia

Major haemorrhage: surgery, trauma, obstetrics and gastrointestinal

Fluid resuscitation

Clinical and laboratory evidence of coagulopathy

Microvascular bleeding

Dilutional coagulopathy

Disseminated intravascular coagulation

Hypothermia, acidosis, hypocalcaemia in massive haemorrhage

Blood salvage (cell salvage)

Use of blood components in the patient who is bleeding

Recombinant factor VIIa in haemorrhage

Anticipated massive transfusion

Management of a bleeding patient who has received fibrinolytics or platelet inhibitors

Systemic fibrinolytics

Aspirin or clopidogrel

Aspirin and clopidogrel

Inhibitors of platelet surface receptors GpIIb/IIIa

High-avidity agents

Low-molecular-weight agents

Cardiac surgery

Liver transplantation and resection

Critical illness

Gastrointestinal haemorrhage: haematemesis and melaena

Transfusion management

Haemoglobin concentration − interpretation

If liver disease is suspected