Patient Blood Management Guideline: Module 1 HOME

l

Contents

l

Index

Patient Blood Management Guidelines: Module 1

Critical Bleeding Massive Transfusion

| Index |

  • A

  • abdominal aortic aneurysms, 20
  • acidosis see metabolic acidosis
  • activated partial thromboplastin time, 32
  • acute respiratory distress syndrome 3, 28, 30, 51-6, 51-9
  • adults
    • blood volume 5, 16
    • massive transfusion in (definition) 5, 16
  • aetiological questions
    • clinical practice guidance, 27
    • evidence gaps, 40
  • aggressive volume resuscitation
    • potential problems, 20
  • allogeneic blood, 40
  • anaemia as independent risk factor
    • anaemia, WHO definition, 27
    • clinical practice guidance, 27
    • evidence gaps, 40
  • antifibrinolytic therapy, 33, 45
  • Australia
    • blood component product information, 52
    • blood sector, 49
  • Australian Health Ministers’ Advisory Council, 49
  • Australian Health Ministers’ Conference, 49
  • Australian Red Cross Blood Service, 49

  • B

  • blood and blood components
    • age of transfused RBCs, 22
    • component therapy, 31, 43
    • component therapy: dose, timing and ratio of, 26, 38, 51
    • fresh frozen plasma, 26, 31, 32, 38, 43, 51-6, 51-9
    • fresh unrefrigerated whole blood, 23
    • product information, 52
    • storage lesion, 22
    • suggested doses, 32
    • transfusion decision, 5, 38, 48
    • triggers for blood component transfusions, 32, 45
    • see also platelets; red blood cells
  • blood loss classification, 19
  • blood management guidelines
    • 2001 guidelines revision, 1, 5, 50
    • content, 8
    • development process, 7, 50
    • evidence-based methodology, 10, 50
    • governance, 7, 47
    • implementing, evaluating and maintaining, 46
    • management framework, 47
    • NHMRC approval, 50
    • public consultation, 50
    • related materials, 9
    • research phase, 50
    • review and finalisation, 7, 47, 47, 50
    • see also clinical practice guidance
  • blood sector
    • Australian, 49
    • New Zealand, 49
  • blood services, 49, 49
  • blood volume
    • adults, 5, 16
    • children, 5
  • ‘bloody vicious cycle’, 25
  • brain injury, 20

  • C

  • Calman Chart, 48
  • cell salvage techniques, 4, 29, 45
  • children
    • blood volume, 5,
    • critical bleeding in, 19
    • massive transfusion in (definition), 5, 19
    • neonates and FUWB, 23
  • clinical assessment, 19
  • Clinical/Consumer Reference Group, 7, 47
    • membership, 47
  • clinical practice guidance
    • dose, timing and ratio of component
    •    therapy effect on outcomes, 26
    • evidence gaps and future research, 36
    • non-transfusion interventions and
    •    haemoglobin concentration, 29
    • physiological parameters effect on
    •    outcomes, 25
    • RBC transfusion effect on outcomes, 28
    • rFVIIa use, 30
    • triggers for blood component transfusions,
    •    32
    • see also blood management guidelines
  • clinical research questions, 12, 50
    • clinical practice guidance, 24
    • evidence gaps, 36
  • Clinical, Technical and Ethical Principal
    • Committee, 49
  • coagulopathy, 20, 21, 25, 25, 26, 51
  • component therapy see under blood and blood
    • components
  • conflict of interest declarations, 47
  • CRASH 2 trial, 3, 33
  • critical bleeding
    • clinical guidance see clinical practice
    •    guidance
    • common causes, 19
    • definitions, 5, 16
    • effect of transfusion, 28
    • initial assessment, 19
    • initial presentation and estimated blood
    •    loss, 20
    • management focus, 19
    • in pregnancy, 16, 26, 34
    • surgical management, 21
    • see alsohaemorrhagic shock
  • cryoprecipitate, 26, 31, 38, 43, 48, 51,
    • 51-6, 51-9
    • product information and dosage, 52, 52
    • suggested doses, 32

  • D

  • damage control surgery, 21
  • disseminated intravascular coagulation, 16, 34
  • dosage of blood products, 32, 52
  • dose, timing and ratio of component therapy
    • effect on outcomes
    •    clinical practice guidance, 26
    •    evidence gaps, 38
    •    evidence matrix, 51

  • E

  • elderly patients, 21
  • erythropoiesis-stimulating agents see nontransfusion interventions
  • evidence-based methodology, 10, 50
    • evidence matrixes, 14, 51
    • evidence statements, 14
    • NHMRC grades for recommendations, 14
    • practice points see practice points
    • recommendations development, 14
    • review and research, 12, 47
    • see also blood management guidelines;
    •    clinical practice guidance
  • evidence gaps, 36
  • evidence statements
    • anaemia as independent risk factor, 27
    • blood component effect, 31, 51-9
    • development of, 14, 50
    • dose, timing and ratio of component therapy
    •    effect, 26, 51, 51-6
    • non-transfusion interventions, 29
    • physiological parameters effect, 25, 51
    • RBC transfusions, 28, 51-6
    • rFVIIa use, 30, 51, 51-9
    • triggers for blood component transfusions,
    •    32
  • Expert Working Group, 7, 47
    • membership, 47

  • G

  • guidelines see blood management guidelines;
    • clinical practice guidance
  • Guidelines Assessment Register consultants,
    • 7, 47, 47, 50 see also blood management
    • guidelines

  • H

  • haematinics see non-transfusion interventions
  • haemoglobin concentration
    • non-transfusion interventions and, 29, 43
  • haemoglobins, synthetic, 45
  • haemorrhage, 16
    • major see critical bleeding
    • obstetric haemorrhage, 16, 26, 34, 40
  • haemorrhagic shock
    • classes of, 20
    • early clinical assessment, 20
    • surgical management, 21
  • hazards/adverse outcomes of transfusion see
    • under transfusions
  • hypothermia, 21, 25, 25, 51

  • I

  • infectious agents
    • risk of transmission, 23, 48
  • international normalised ratio (INR), 25, 32
  • interventional questions
    • clinical practice guidance, 26, 28
    • evidence gaps, 36
  • iron (non-transfusion intervention) see non-
    • transfusion interventions

  • J

  • Jurisdictional Blood Committee, 49

  • L

  • ‘lethal triad’, 25
  • literature review, 7, 12, 13, 47, 50

  • M

  • massive transfusion
    • in adults, 5, 16
    • in children, 5, 16
    • definitions, 5, 16
  • massive transfusion protocol template, 4, 53
    • activation and cessation guidelines, 34
    • activation criteria, 4, 53
    • local adaptation, 34
    • for obstetric patients, 34 see also obstetric
    •    haemorrhage
  • Medsafe, 49
  • metabolic acidosis, 21, 25, 25, 51
  • methodology see evidence-based methodology
  • minimal volume resuscitation, 20
  • Ministry of Health (NZ), 49
  • morbidity
    • dose, timing and ratio of component therapy
    •    effect, 26, 38, 51
    • non-transfusion interventions to increase
    •    haemoglobin concentration, 29, 43
    • rFVIIa use, 30 , 51
    • see also trauma
  • mortality
    • dose, timing and ratio of component therapy
    •    effect, 26, 38, 51
    • FFP or platelet transfusion, 31
    • ‘lethal triad’/’bloody vicious cycle’, 25
    • non-transfusion interventions to increase
    •    haemoglobin concentration, 29, 43
    • predictors of, 25
    • RBC transfusions and, 28, 40, 51-6
    • rFVIIa use, 30 , 51
    • trauma survival and tranexamic acid, 33
    • and variation of physiologic, biochemical and
    •    metabolic parameters, 38, 51
    • see also survival

  • N

  • National Blood Authority, 7, 47, 49
  • National Health and Medical Research Council
    • approval of guidelines, 50
    • NHMRC grades for recommendations, 14
  • neonates, 21
  • New Zealand
    • blood component product information, 52
    • blood sector, 49
  • New Zealand Blood Service, 49
  • non-transfusion interventions
    • clinical practice guidance, 29
    • evidence gaps, 43

  • O

  • obstetric haemorrhage, 16, 26, 34, 40
  • oxygen therapeutics, 45

  • P

  • patient blood management
    • guidelines see blood management
    •    guidelines
    • principles, 5
    • transfusion decision, 5, 38, 48
    • transfusion risks, 48 see also transfusions
  • Patient Blood Management Guidelines see
    • blood management guidelines
  • patient outcomes
    • blood component effect, 31, 43, 51-9
    • dose, timing and ratio of component therapy
    •    effect, 26, 38, 51
    • non-transfusion interventions, 29, 43
    • physiological parameters effect, 25, 38,
    •    51
    • RBC transfusion effect, 28
    • rFVIIa use, 30 , 43, 51
  • patients
    • critical physiologic derangement indications,
    •    25
    • early clinical assessment, 19
    • initial presentation and estimation of blood
    •    loss, 20
    • mortality or survival predictions, 25
    • parameters to be measured early and
    •    frequently, 25
  • permissive hypotension, 20
  • physiological parameters, effect on outcomes
    • clinical practice guidance, 25
    • evidence gaps, 38
    • evidence matrix, 51
  • PICO (‘population, intervention, comparator and
    • outcome) criteria, 50
  • plasma see fresh frozen plasma
  • platelets
  • point-of-care testing, 32, 45
  • postpartum haemorrhage, 16 see also obstetric
    • haemorrhage
  • PPO (‘population, predictor and outcome)
    • criteria, 50
  • practice points
    • anaemia, 27, 40
    • blood components suggested doses, 32
    • development of, 14, 50
    • dose, timing and ratio of component
    •    therapy, 26
    • effect of physiological parameters on
    •    outcomes, 25
    • RBC transfusion effect, 29
    • rFVIIa use, 30
    • summary of, 3
    • triggers for blood component transfusions,
    • 32
  • pregnancy
  • PRO (‘population, risk factor and outcome’)
    • criteria, 50
  • prognostic questions
    • clinical practice guidance, 25, 32
    • evidence gaps, 36, 45
  • prolonged partial thromboplastin time, 25
  • prothrombin time (PT)/activated partial
    • thromboplastin time (APTT), 32
  • protocol see massive transfusion protocol
    • template
  • public consultation, 50

  • R

  • ratio of component therapy see dose, timing
    • and ratio of component therapy effect on
    • outcomes
  • recombinant activated factor VII use
    • clinical practice guidance, 30
    • evidence gaps, 43
    • evidence matrixes, 51
  • recommendations
    • development of, 2, 14
    • for dose, timing and ratio of component
    •    therapy, 26
    • NHMRC grades, 2, 14
    • for rFVIIa use, 30
  • red blood cells
    • age of transfused RBCs, 22
    • dose, timing and ratio of component
    •    therapy effect on outcomes, 26, 38,
    •    51
    • RBC/FFP ratio associated with reduced
    •    mortality, 31
    • RBC transfusion effect on outcomes, 28,
    • 40
  • research, 12, 50
    • background research, 13, 47
    • clinical research questions, 12, 24
    • literature review, 7, 12, 13, 47, 50
    • research required, 36
  • resuscitation
    • aggressive volume resuscitation, 20
    • minimal volume resuscitation, 20
  • review process see evidence-based
    • methodology; systematic review process
    • (blood management guidelines)
  • review questions see clinical research
    • questions
  • rFVIIa see recombinant activated factor VII
    • use
  • ruptured abdominal aortic aneurysms, 19, 20

  • S

  • Steering Committee, 7, 47
    • membership, 47
  • storage lesion, 22
  • surgery
    • bleeding due to surgery, 45
    • early surgical management, 21
    • fresh whole blood use, 23
    • rFVIIa use, 30
    • see also trauma
  • survival
    • benefit of permissive hypotension and
    •    minimal volume resuscitation, 20 see
    •    also mortality
    • RBC transfusions and, 40, 51
    • survival predictions in patients, 25
    • trauma survival and tranexamic acid, 25
  • synthetic haemoglobins, 45
  • systematic review process (blood
    • management guidelines), 7, 12, 47
    •    team members, 47
    •    see also clinical research questions;
    •    evidence-based methodology

  • T

  • technical reports, 9
  • technical writers, 7, 47, 47
  • Therapeutic Goods Administration, 49
  • thrombocytopenia, 20, 25, 25, 51
  • thromboelastography, 32, 45
  • thromboelastometry, 45
  • thromboembolism, 51
  • timing of component therapy see dose, timing
    • and ratio of component therapy effect on
    • outcomes
  • tranexamic acid
    • dosage, 33
    • effect on survival of trauma patients, 33
  • transfusion decision, 5, 38, 48
  • transfusion rate
    • dose, timing and ratio of component
    •    therapy effect, 26, 38, 51
    • physiological parameters effect, 25, 38, 51
    • rFVIIa use, 30, 43, 51
  • transfusion risks, 48
  • transfusions
    • adverse outcomes, 5, 28, 40, 48
    • dose, timing and ratio of component
    •    therapy effect on outcomes, 26, 38,
    •    51
    • FFP or platelet transfusion, 31
    • need for, 29, 43, 51-9
    • RBC transfusion effect on patient
    •    outcomes, 28
    • rFVIIa use effect on transfusion rate, 30 ,
    •    43, 51
    • time-dependent changes in stored blood
    •    and patient outcomes, 22
    • triggers for blood component transfusions,
    •    32, 45
    • use of fresh unrefrigerated whole blood, 23
    • see also non-transfusion interventions
  • trauma
    • evidence matrixes, 51
    • trauma survival and tranexamic acid, 33
    • traumatic brain injury, 20
  • triggers for blood component transfusions
    • clinical practice guidance, 32
    • evidence gaps, 45