scholarly journals Gender differences in blood transfusion strategy for patients with hip fractures - a retrospective analysis

2020 ◽  
Vol 17 (5) ◽  
pp. 620-625
Author(s):  
Rene Burchard ◽  
Alina Daginnus ◽  
Christian Soost ◽  
Jan Schmitt ◽  
Jan Adriaan Graw
Keyword(s):  
Gender Differences ◽  
Blood Transfusion ◽  
Retrospective Analysis ◽  
Hip Fractures ◽  
Transfusion Strategy

Informed consent in interventional radiology – are we doing enough?

2021 ◽  
pp. 20201368
Author(s):  
Akash Prashar ◽  
Saqib Butt ◽  
Davide Giuseppe Castiglione ◽  
Nadeem Shaida
Keyword(s):  
Interventional Radiology ◽  
Clinical Practice ◽  
Informed Consent ◽  
Blood Transfusion ◽  
Retrospective Analysis ◽  
Patient Information ◽  
Potential Risk ◽  
Current Model ◽  
Consent Form ◽  
Consent Process

Objectives: Obtaining informed consent is a mandatory part of modern clinical practice. The aim of this study was to identify how often complications relating to Interventional Radiology (IR) procedures were discussed with the patient prior to the procedure. Methods: A retrospective analysis of 100 patients who experienced a complication related to an IR procedure was performed. The patient’s procedure consent form was examined to identify whether the complication they experienced had been discussed as a possible risk. Other parts of the consent form relating to need for blood transfusion and the need for further procedures were also examined. Results: 39% of patients who experienced a complication did not have the complication documented as a potential risk on the consent form. 14% of patients required a blood transfusion but were not consented for this. 42% of patients required a further procedure or operation but were not warned of this. Conclusion: The model of gaining informed consent on the day of procedure is no longer valid. Better education and the use of clinics, patient information sheets and other resources is essential. Advances in knowledge: The paper highlights the inadequacies of the current model in gaining consent for IR procedures. A more comprehensive consent process making use of all available resources is essential.

scholarly journals BLOOD TRANSFUSION IN CARDIAC SURGERY- NEED TO FOLLOW BASICS!

2020 ◽  
Vol 7 (3) ◽  
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Red Blood Cell Transfusion ◽  
Transfusion Strategy ◽  
Transfusion Threshold ◽  
Restrictive Transfusion ◽  
Conflicting Evidence ◽  
American Society

More and more data is coming in recent times about hazards of blood transfusion. In a landmark TRICC1 trial Euvolemic patients in the intensive care unit (ICU) with Hb<9 g/dl were randomized to a restrictive transfusion strategy for transfusion of PRBCs (transfused if Hb<7 g/dl to maintain Hb between 7 and 9 g/dl) or a liberal strategy (transfused if Hb<10 g/dl to maintain Hb 10-12 g/dl). Mortality was similar in both groups, indicating that liberal transfusions were not beneficial. An Updated Report by the American Society of AnaesthesiologistsTask Force on Perioperative Blood Management tells us restrictive red blood cell transfusion strategy may be safely used to reduce transfusion administration. It further states that The determination of whether hemoglobin concentrations between 6 and 10 g/dl justify or require red blood cell transfusion should be based on potential or actual on going bleeding (rate and magnitude), intravascular volume status, signs of organ ischemia, and adequacy of cardiopulmonary reserve. Should we extrapolate these guidelines in Cardiac surgery? TRACS2 trial concluded that among patients undergoing cardiac surgery, the use of a restrictive perioperative transfusion strategy compared with a more liberal strategy resulted in noninferior rates of the combined outcome of 30-day all-cause mortality and severe morbidity.They advocated use of restrictive strategy, but 5 years later, the authors 3concluded that A restrictive transfusion threshold after cardiac surgery was not superior to a liberal threshold with respect to morbidity or health care costs. With this conflicting evidence, by which way anaesthesiologist to go?

515 Compliance with a Restrictive Blood Transfusion Strategy: Do We Actually Follow Scientific Evidence?

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S95-S95
Author(s):  
David L Wallace ◽  
Alan D Rogers ◽  
Robert Cartotto
Keyword(s):  
Blood Transfusion ◽  
Scientific Evidence ◽  
Inhalation Injury ◽  
Transfusion Strategy ◽  
Restrictive Transfusion ◽  
Burn Care ◽  
Trigger Strategy ◽  
Transfusion Requirements ◽  
Before And After ◽  
Restrictive Transfusion Strategy

Abstract Introduction Many burn centers use a restrictive blood transfusion strategy based on randomized controlled trials in burn patients (e.g. Transfusion Requirements in Burn Care Evaluation -TRIBE) and non-burn populations (e.g. Transfusion Requirements in Critical Care – TRICC), which have demonstrated no increased morbidity or mortality between restrictive and liberal transfusion approaches. The purpose of this study was to evaluate the adherence to a restrictive hemoglobin transfusion trigger strategy of 7 g/dL. Methods Retrospective study of all patients admitted to an adult regional ABA-verified burn centre between 15/11/ 2015 and 15/6/2018 who received at least one unit of blood (RBC). We use a restrictive transfusion strategy that administers RBC for a hemoglobin (HGb) &lt; 7 gm/dL, one unit at a time, with a pre and post HGb level for each RBC transfusion, unless the patient is actively bleeding and/or hemodynamically unstable. RBC transfusions in the operating room do not follow this policy and were not studied. Values are presented as mean ± SD or median (IQR) as appropriate. Results We studied 66 patients (30% female) with age 53.2 ± 18.3 years, % TBSA burn 22 (11–41), % TBSA full thickness burn 6.5 (0.5 -21.8), and with 41% having inhalation injury. Overall, there were 691 RBC transfusions (TXns). A pre-TXn HGb was obtained 95% of the time and was 6.8 (6.5–7) gm/dL. TXn for a HGb &gt; 7 gm/dL occurred in 35%. A post TXn HGb was obtained for 92% of these TXns with a HGb of 7.6 (7.2–8) gm/dL. RBC TXns during nighttime (1700 to 0800, n=449) were given for a HGb trigger of 6.8 (6.4–6.9) and were not compliant with our restrictive strategy 22% of the time. Daytime transfusions (0800 to 1700, n=207) were given for a significantly higher HGb [7 (6.7–7.1), p&lt; 0.001] with significantly more non-compliance with the restrictive strategy (50%, p&lt; 0.001). We also compared TXns before and after the TRIBE publication. Pre-TRIBE TXns (n=484) were given for significantly lower HGb than 172 post TRIBE TXns [6.8 (6.4–7) vs 6.9 (6.6–7.1) gm/dL respectively, p=0.001] and at significantly lower rate of non-compliance with the 7 gm/dL threshold than post TRIBE transfusions (28.1% vs 37.8%, respectively, p=0.02). Conclusions While a pre-TXn HGb level was available for 95% of blood transfusions, approximately one-third were given for a HGb &gt; 7 gm/dL. Transfusion during nighttime (being predominantly ordered by housestaff physicians) were administered at a significantly lower HGb trigger and with significantly better compliance with the restrictive strategy than daytime transfusions. Paradoxically, compliance with the restrictive strategy was worse following the TRIBE publication. Applicability of Research to Practice These results identify important areas for improvement in adherence to our restrictive transfusion strategy.

Ebola: a call for blood transfusion strategy in sub-Saharan Africa

The Lancet ◽  
2014 ◽  
Vol 384 (9951) ◽  
pp. 1347-1348 ◽  
Author(s):  
Thierry Burnouf ◽  
Jean Emmanuel ◽  
Dora Mbanya ◽  
Magdy El-Ekiaby ◽  
William Murphy ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Sub Saharan Africa ◽  
Transfusion Strategy ◽  
Sub Saharan

scholarly journals Predicting the need for blood transfusion in patients with hip fractures

2013 ◽  
Vol 37 (4) ◽  
pp. 693-700 ◽  
Author(s):  
Assaf Kadar ◽  
Ofir Chechik ◽  
Ely Steinberg ◽  
Evgeny Reider ◽  
Amir Sternheim
Keyword(s):  
Blood Transfusion ◽  
Hip Fractures
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