Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Blood donation wikipedia , lookup
Hemorheology wikipedia , lookup
Men who have sex with men blood donor controversy wikipedia , lookup
Hemolytic-uremic syndrome wikipedia , lookup
Plateletpheresis wikipedia , lookup
Blood transfusion wikipedia , lookup
Jehovah's Witnesses and blood transfusions wikipedia , lookup
Blood Transfusion Consultant CPD, November 23rd 2016 Blood is good Blood is good DO2 = CO x CaO2 Blood is bad Pull out Betty! You’ve hit an artery Blood is bad Infections Transfusion reactions TRALI TACO Chemical effects due to storage Microcirculation Immunomodulation Blood is bad Infections Transfusion reactions TRALI TACO Chemical effects due to storage Microcirculation Immunomodulation Blood is bad Happy medium? Happy medium? Restrictive transfusion The policy of giving blood only when benefits are deemed to outweigh potential risks Restrictive vs liberal transfusion strategies Restrictive vs liberal transfusion strategies The evidence Restrictive vs liberal transfusion strategies 7 key RCTs General / critical care population Cardiac patients [TBI and SAH] The TRICC study The TRICC study LIBERAL Hb 100 -120 RESTRICTIVE Hb 70 -90 OUTCOMES Death at 30 days & 60 days, organ failures The TRICC study LIBERAL Hb 107 ± 7 (5.6 ± 5.3) RESTRICTIVE (2.6 ± 4.1) Hb 85 ± 7 P<0.01 The TRICC study The TRICC study The TRICC study The TRICC study The TRICC study The FOCUS study The FOCUS study 2016 pts >50yrs IHD or risk factors Hb <100 ♯ hip The FOCUS study The FOCUS study LIBERAL Hb >100 RESTRICTIVE Hb < 80 or signs & symptoms OUTCOMES Death at 60 days or inability to walk >10ft The FOCUS study The FOCUS study The FOCUS study The FOCUS (2)study The FOCUS (2) study The RELIEVE study >55yrs CCM The RELIEVE study LIBERAL Hb>90 (91-110) RESTRICTIVE Hb>70 (71-90) OUTCOMES Difference in mean Hb, mortality, adverse events, HRQoL The RELIEVE study The RELIEVE study No significant difference in mortality or any of the other outcome measures Ischaemic Heart Disease IHD pts Am Heart Journal 2011; 162:300 IHD pts Hospital-acquired anemia was defined as development of new anemia during hospitalization using age, gender, and race specific criteria Mild – less than normal - >110 Moderate – 90-110 Severe - <90 IHD pts The MINT study The MINT study STEMI Non STEMI Unstable angina Cardiac catheter Hb<100 The MINT study LIBERAL Hb >100 RESTRICTIVE Symptomatic Hb < 80 OUTCOMES Death, MI, unscheduled revascularisation The MINT study The MINT study The TRACS study The TRACS study LIBERAL Ht >30 RESTRICTIVE Ht >24 OUTCOMES Death, severe morbidity (CVS, RS, Renal) The TRACS study The TRACS study The TRACS study Upper GI bleed pts Upper GI bleed pts LIBERAL Hb 90 -110 RESTRICTIVE Hb 70 -90 OUTCOMES Death at 45 days, re-bleed, in hospital complications Upper GI bleed pts No transfusion 51% vs 14% Upper GI bleed pts Upper GI bleed pts The TRISS study The TRISS study The TRISS study LIBERAL Hb >90 RESTRICTIVE Hb >70 OUTCOMES Death at 90 days The TRISS study The TRISS study The TRISS study The TITRe2 study The TITRe2 study LIBERAL Hb >90 RESTRICTIVE Hb >75 OUTCOMES 10 - Sepsis, Ischaemic events within 3 months 20 - ICU stay, all cause mortality The TITRe2 study RESULTS 10 outcome 35% vs 33% 20 outcome 4.2 vs 2.6% Protocol violations TBI & SAH patients TBI & SAH patients Transfusion Medicine 2016 TBI & SAH patients Very sparse evidence For TBI Hb 70 – 90 For SAH 80 - 100 TBI & SAH patients JAMA 2014 TBI & SAH patients TBI & SAH patients TBI & SAH patients Cochrane review Cochrane review 19 trials 6264 pts Cochrane review Adverse events and other outcomes None of the outcomes evaluated, including mortality, cardiac morbidity, infections and length of hospital stay, appear to be adversely affected by the lower use of red cell transfusions. Cochrane review In contrast, the evidence raises the possibility of harm associated with liberal transfusion. In-hospital mortality increased by 23% infections were increased by19% . Cochrane review In patients who do not have acute coronary artery disease, blood transfusion can probably be withheld in the presence of haemoglobin levels as low as 70 to 80 as long as there is no notable bleeding. NICE recommendations Red blood cells Thresholds and targets Use restrictive red blood cell transfusion thresholds for patients who need red blood cell transfusions and who do not: have major haemorrhage or have acute coronary syndrome or need regular blood transfusions for chronic anaemia. . NICE recommendations Red blood cells Thresholds and targets When using a restrictive red blood cell transfusion threshold, consider a threshold of 70 g/litre and a haemoglobin concentration target of 70–90 g/litre after transfusion. Consider a red blood cell transfusion threshold of 80 g/litre and a haemoglobin concentration target of 80–100 g/litre after transfusion for patients with acute coronary syndrome. Questions?