Patient Blood Management Guidelines: Module 1
Critical Bleeding Massive Transfusion
Contents
- Abbreviations and acronyms
Executive summary - Summary of recommendations
- Summary of practice points
- Massive transfusion protocol template
- 1Introduction
- 1.1Development of the guidelines
- 1.2Governance structure
- 1.3Structure of the document and related
materials - 1.3.1 The document
- 1.3.2 Related materials
- 2Methods
- 2.1Clinical research questions – development and
details - 2.2Review and research
- 2.2.1 Systematic review process
- 2.2.2 Background material
- 2.3Development of evidence statements,
recommendations and practice points - 3Background
- 3.1Definitions
- 3.1.1 Critical bleeding
- 3.1.2 Massive transfusion
- 3.2Pregnancy and children
- 3.2.1 Critical bleeding in pregnancy
- 3.2.2 Critical bleeding in children
- 3.3Early clinical assessment
- 3.4Permissive hypotension and minimal volume
resuscitation - 3.5Early surgical management
- 3.6Blood
- 3.6.1 Age of transfused red blood cells
- 3.6.2 Fresh whole blood
- 4Clinical practice guidance based on
evidence or consensus - 4.1Effect of physiological parameters
on outcomes - 4.2Effect of dose, timing and ratio of component
therapy on outcomes - 4.3Effect of anaemia on outcomes
- 4.4Effect of red cell transfusion on outcomes
- 4.5Effect of non-transfusion interventions to
increase haemoglobin concentration - 4.6Effect of recombinant activated factor
VII onoutcomes - 4.7Effect of blood components on outcomes
- 4.8Triggers for blood component transfusion
- 4.9Effect of tranexamic acid
- 4.10Development of a massive transfusion
protocol - 4.10.1 Local adaptation
- 4.10.2 Activation and cessation
- 5Future directions
- 5.1Evidence gaps and areas of future research
- 5.1.1 Effect of physiological parameters
on outcomes - 5.1.2 Effect of dose, timing and ratio
of component therapy on outcomes - 5.1.3 Effect of anaemia on outcomes
- 5.1.4 Effect of red cell transfusion
on outcomes - 5.1.5 Effect of non-transfusion interventions
to increase haemoglobin concentration - 5.1.6 Effect of recombinant activated factor
VII on outcomes - 5.1.7 Effect of blood components on
outcomes - 5.1.8 Triggers for blood component
transfusion - 5.2Topics for future consideration
- 6Implementing, evaluating and maintaining
the guidelines - Appendix AGovernance
- Appendix BTransfusion risks in the context
of patient blood management - Appendix CBlood sectors
- Appendix DProcess report
- Appendix EEvidence matrixes
- Appendix FProduct information
- Appendix GMassive transfusion protocol
template - References
- Tables
- Table 1.1Phases of development of guideline
modules - Table 2.1Details of question types
- Table 2.2Body of evidence matrix
- Table 2.3Definitions of NHMRC grades for
recommendations - Table 3.1Estimated blood loss based on patient’s
initial presentation - Table B.1Transfusion risks and benefits
- Table B.2Transfusion risks in perspective
- Table B.3Calman Chart a (UK risk per one year)
- Table F.1Blood component product information
and dosage – Australia - Table F.2Blood component product information
and dosage – New Zealand - Figures
- Figure A1Management framework
for development of the guidelines - Boxes
- Box 2.1Systematic Review Questions
- Box 2.2Background Research Questions
© Commonwealth of Australia 2011
Printed document
This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and enquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney-General’s Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at www.ag.gov.au/cca
ISBN Print: 978-0-9775298-5-8
Electronic document
This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, noncommercial use or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved. Requests and enquiries concerning reproduction and rights should be addressed to Commonwealth Copyright Administration, Attorney-General’s Department, National Circuit, Barton ACT 2600 or posted at www.ag.gov.au/cca
ISBN Online: 978-0-9775298-6-5
For further information:
Patient Blood Management Guidelines
National Blood Authority
Locked Bag 8430
Canberra ACT 2601
Telephone: +61 2 6151 5000
Email: guidelines@blood.gov.au
Web site: www.blood.gov.au
Publication Approval
These guidelines were approved by the Chief Executive Officer of the National Health and Medical Research Council (NHMRC) on Friday 12th November 2010, under Section 14A of the National Health and Medical Research Council Act 1992. In approving these guidelines the NHMRC considers that they meet the NHMRC standard for clinical practice guidelines in that they are based on the systematic identification and synthesis of the best available scientific evidence and make clear recommendations for health professionals practising in an Australian health care setting. The NHMRC expects that all guidelines will be reviewed no less than once every five years.
This publication reflects the views of the authors and not necessarily the views of the Australian Government.
Patient Blood Management Guidelines:
Module 1 – Critical Bleeding /Massive Transfusion
Development of this module was achieved through clinical input and expertise of representatives from the Colleges and Societies listed below and an independent consumer advocate (see Appendix A).The National Blood Authority gratefully acknowledges these contributions.
Australasian College for Emergency Medicine
Australian and New Zealand College of Anaesthetists
Australian and New Zealand Intensive Care Society
Australian and New Zealand Society of Blood Transfusion
Australian Orthopaedic Association
Australian Red Cross Blood Service
College of Intensive Care Medicine of Australia and New Zealand
Haematology Society of Australia and New Zealand
Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Royal Australasian College of Physicians
Royal Australasian College of Surgeons
Royal College of Nursing Australia
Royal College of Pathologists of AustralasiaThalassaemia Australia
College and Society endorsement of this Module can be found at www.blood.gov.au
Disclaimer
This document is a general guide to appropriate practice, to be followed subject to the circumstances, clinician’s judgement and patient’s preferences in each individual case. It is designed to provide information to assist decision making. Recommendations contained herein are based on the best available evidence published up to July 2009. The relevance and appropriateness of the information and recommendations in this document depend on the individual circumstances. Moreover, the recommendations and guidelines are subject to change over time.
Each of the parties involved in developing this document expressly disclaims and accepts no responsibility for any undesirable consequences arising from relying on the information or recommendations contained herein.
Funding and project management
Funding, Secretariat and Project Management was provided by the National Blood Authority Australia.The development of the final recommendations has not been influenced by the views or interests of the funding body.
Technical Editing by Cadman Editing Services Canberra.
Printed document
This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and enquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney-General’s Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at www.ag.gov.au/cca
ISBN Print: 978-0-9775298-5-8
Electronic document
This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, noncommercial use or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved. Requests and enquiries concerning reproduction and rights should be addressed to Commonwealth Copyright Administration, Attorney-General’s Department, National Circuit, Barton ACT 2600 or posted at www.ag.gov.au/cca
ISBN Online: 978-0-9775298-6-5
For further information:
Patient Blood Management Guidelines
National Blood Authority
Locked Bag 8430
Canberra ACT 2601
Telephone: +61 2 6151 5000
Email: guidelines@blood.gov.au
Web site: www.blood.gov.au
Publication Approval
These guidelines were approved by the Chief Executive Officer of the National Health and Medical Research Council (NHMRC) on Friday 12th November 2010, under Section 14A of the National Health and Medical Research Council Act 1992. In approving these guidelines the NHMRC considers that they meet the NHMRC standard for clinical practice guidelines in that they are based on the systematic identification and synthesis of the best available scientific evidence and make clear recommendations for health professionals practising in an Australian health care setting. The NHMRC expects that all guidelines will be reviewed no less than once every five years.
This publication reflects the views of the authors and not necessarily the views of the Australian Government.
Patient Blood Management Guidelines:
Module 1 – Critical Bleeding /Massive Transfusion
Development of this module was achieved through clinical input and expertise of representatives from the Colleges and Societies listed below and an independent consumer advocate (see Appendix A).The National Blood Authority gratefully acknowledges these contributions.
Australasian College for Emergency Medicine
Australian and New Zealand College of Anaesthetists
Australian and New Zealand Intensive Care Society
Australian and New Zealand Society of Blood Transfusion
Australian Orthopaedic Association
Australian Red Cross Blood Service
College of Intensive Care Medicine of Australia and New Zealand
Haematology Society of Australia and New Zealand
Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Royal Australasian College of Physicians
Royal Australasian College of Surgeons
Royal College of Nursing Australia
Royal College of Pathologists of AustralasiaThalassaemia Australia
College and Society endorsement of this Module can be found at www.blood.gov.au
Disclaimer
This document is a general guide to appropriate practice, to be followed subject to the circumstances, clinician’s judgement and patient’s preferences in each individual case. It is designed to provide information to assist decision making. Recommendations contained herein are based on the best available evidence published up to July 2009. The relevance and appropriateness of the information and recommendations in this document depend on the individual circumstances. Moreover, the recommendations and guidelines are subject to change over time.
Each of the parties involved in developing this document expressly disclaims and accepts no responsibility for any undesirable consequences arising from relying on the information or recommendations contained herein.
Funding and project management
Funding, Secretariat and Project Management was provided by the National Blood Authority Australia.The development of the final recommendations has not been influenced by the views or interests of the funding body.
Technical Editing by Cadman Editing Services Canberra.