Blood: Blood: A Conversation A Conversation about Conservation about Conservation (aka Patient Blood (aka Patient Blood Management) Management) Dr Biddy Ridler Dr Biddy Ridler Blood Conservation Specialty Doctor Blood Conservation Specialty Doctor Exeter Surgical Society Exeter Surgical Society 3rd October 2013 3rd October 2013
30
Embed
Blood a conversation about conservation ex ss 1010113
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Blood: Blood: A Conversation A Conversation
about Conservationabout Conservation(aka Patient Blood Management)(aka Patient Blood Management)
Dr Biddy RidlerDr Biddy RidlerBlood Conservation Specialty DoctorBlood Conservation Specialty Doctor
Exeter Surgical SocietyExeter Surgical Society3rd October 20133rd October 2013
Blood Conservation:Blood Conservation:[‘[‘Preservation, protection…prevention Preservation, protection…prevention of wasteful use of a resource’ OED]of wasteful use of a resource’ OED]
• Why conserve bloodWhy conserve blood
• Current laws / guidelinesCurrent laws / guidelines
Are there concerns about infected Are there concerns about infected blood – if so why?blood – if so why?
Donors lost – safety and testingDonors lost – safety and testing
• HIV, hepatitis, syphilis and moreHIV, hepatitis, syphilis and more
• vCJD vCJD exclusion if previous transfusion (> 3.5%)exclusion if previous transfusion (> 3.5%) screening test for vCJD announced 3.2.11screening test for vCJD announced 3.2.11 donors may fear the implications of a donors may fear the implications of a
positive testpositive test
• Malaria, West Nile virusMalaria, West Nile virus
• What else is out there?What else is out there?
Why conserve blood – Why conserve blood – are there any national references?are there any national references?• Blood conservation / shortageBlood conservation / shortage
Current Guidelines: red cellsCurrent Guidelines: red cells
BCSH guidelines & endorsed by NBTCBCSH guidelines & endorsed by NBTC(NICE consultation 2013 )(NICE consultation 2013 )
• Acute blood lossAcute blood loss up to 30% blood loss – crystalloid/colloidup to 30% blood loss – crystalloid/colloid 30% loss - RBC usually required30% loss - RBC usually required
• Peri-operative – assuming normovolaemiaPeri-operative – assuming normovolaemia Hb < 7g/dlHb < 7g/dl Hb < 8g/dl if known CVD/risk factors for CVDHb < 8g/dl if known CVD/risk factors for CVD
• Secondary endpoints - health related quality of Secondary endpoints - health related quality of life, post-operative morbidity, safety and length life, post-operative morbidity, safety and length of hospital stayof hospital stay
• National Blood Transfusion CommitteeNational Blood Transfusion Committee
• International SocietiesInternational Societies
3 pillars of patient blood management3 pillars of patient blood management(Hofmann A, Friedman D, Farmer S, 2008)(Hofmann A, Friedman D, Farmer S, 2008)
The future #1The future #1• Further decrease in blood stocksFurther decrease in blood stocks
• Further decrease for surgeryFurther decrease for surgery Minimal blood orderingMinimal blood ordering Cell salvage, sealantsCell salvage, sealants Minimal invasive surgeryMinimal invasive surgery
Increase for medicine Increase for medicine AUGIB, Haemo-oncologyAUGIB, Haemo-oncology
The future #2
• AB, B,A Group conversion to O
• Embryonic stem cellsO neg
• Oxygen carrying solutions
- Haemoglobin derived
- Perfluorocarbons
• ‘Quikclot’
International concerns International concerns about blood transfusionabout blood transfusion
• Availability
• Economics
• Obsession with safety but not efficacy
• Preoperative anaemia carries risks……
• …….But so does transfusion
• PBM is emotional rather than rational
• PBM should be pre-emptive
• Increase for AUGIB and Haem-oncology
How can How can youyou can help? can help? • Consider the need for blood productsConsider the need for blood products• Be aware of the problemsBe aware of the problems
training, competencies, policiestraining, competencies, policies• Optimise patients earlyOptimise patients early – on referral – on referral
• Use blood wiselyUse blood wisely Clinical indicationsClinical indications Current HbCurrent Hb Risks/benefitsRisks/benefits Consider alternativesConsider alternatives
Transfusing blood safely and Transfusing blood safely and appropriately Murphy M et al appropriately Murphy M et al
BMJ 2013;347:f4303 BMJ 2013;347:f4303
Take Home MessageTake Home MessagePatient Blood ManagementPatient Blood Management
““The optimal use of this scarce, expensive The optimal use of this scarce, expensive and potentially infectious resource is of and potentially infectious resource is of
international importance”international importance” McGill N et alMcGill N et al BMJ 2002;324(7439):1299BMJ 2002;324(7439):1299