New cryo SOP - have gotten questions on how to calculate a dose...?

[lalamb]

We are writing a new cryo SOP ....our facility hasn't  stock it in the past.

 

thought I had it nice and simple, included the "Suggested Adult Flow Rates" from AABB,then a question popped up...

 

Dr wanted to know how to calculate how many units to give? Pt in question is vWD, (unsure if they'r Type 1,2 or 3), slow abd bleeding

 

We rec pooled units from our supplier ( 1 pooled unit = 5 single untis)

The tech did a good job of researching it but the math looks cumbersume, and there are multiple formula.

 

What do others do....if anything?

 

Our local university said: give 2 pooled units for an adult, and a 3rd if they need it.

A provider on line organization said: same as above

AABB : dose(untis) = (Desired fibrinogen increment in mg.dl) X plasma volume (dL) / 250 mg /unit

 

Circular of information (2009) :

• for fibrinogen: # of bags = 0.2 X body weight in kg
• for Factor VIII: # of bags = desired increase in F8 level in % X 40 X body weight in kg/average units of F8 per bag.

Circular of Information (2013) :

 

• for fibrinogen: # 1 bag per 7-10 kb body wt t raise plasma fibringon by apporx 50-75 mg/dL
• for Factor VIII: # of bags = desired increase in F8 level in % X 40 X body weight in kg/average units of F8 per bag.

 

????????????? hope I transcribed the formula correctly

 

 

 

[Auntie-D]

We just go by 10ml per kg (and 20ml per kg for ffp). I've never questioned this - perhaps I should

[Malcolm Needs ☆]

I wouldn't recommend questioning it Auntie-D - it comes from the BCSH Guidelines, which will only include such figures if there is a very good reason to so do.

[Auntie-D]

I wouldn't recommend questioning it Auntie-D - it comes from the BCSH Guidelines, which will only include such figures if there is a very good reason to so do.

I meant questioning where he values came from. Maybe the SOP should be amended to include that as a reference

[tbostock]

We would use Humate P for Von Willebrands, cryo would be only if that product was not available.

[pbaker]

The guidelines on our transfusion order form state:

"If fibrinogen is less than 100, give 10 units.  If fibrinogen is less than 50, give 20 units."

We only stock pooled cryo (1 pool = 5 units)

[Joanne P. Scannell]

Ummm, yeah ... that looks right. 

 

Precisely why the MDs don't bother with the math.

 

AABB ... who's going to calculate total plasma volume?

 

Circular of Info (2013!?):  So for an average sized person (70kg) with a 50mg/dL Fibrinogen (our transfusion audit trigger), the math says to give 7 bags to raise the level to 100-125mg/dL.

 

Since the pools are 5 bags each, we have to give 2 pools to accomplish this ... even if the math said give 6 ... or 8 ... or 9 ... we'd still give 2 pools ... and that seems to be the trend 'policy' around here.

 

We are just starting up with pools, too.  I'm planning on putting in our SOP 'if patient weighs less than 50kg, give 1 pool.'  ... if 70kg or greater, give 2 pools'.  Of course, here in the USA, we have to translate that to pounds!

 

Ok, now WHO decided that a pool should be only 5 bags!? 

[Malcolm Needs ☆]

Believe me Joanne, as I am now very old and wrinkly, I, too, have to translate back from Kg to pounds!