Transfusion in emergencies

[mpmiola]

I need your opinion on an internal protocol.

The doctor wants liberemos 2 units of blood transfused O- to care for polytrauma, before the patient arrives at the hospital. Will install as soon as the patient arrives.

He said he wants to reduce the infusion of plasma expanders because it interferes with the surgical procedures.

Will certainly increase our consumption of O-.

Plasma expander interferes with the surgery?

What do you think?

 

[tbostock]

I've heard for trauma in general that they are using less colloids/crystalloids because they found that giving patient many liters of these is not as helpful as they believed, and tends to increase coagulopathy by dilution.

[David Saikin]

We use group O Pos (unxm) for all traumas except females <50 yrs old.

[Auntie-D]

You wouldn't want to be using group O plasma - would need to be group AB...

Recent studies show blood:plasma at a ratio of 1:1 decreases coagulopathy problems, allows cessation of the bleeding quicker and allows less blood to be used. FFP is cheap and low risk so throw it at them

[Auntie-D]

You wouldn't want to be using group O plasma - would need to be group AB...

Recent studies show blood:plasma at a ratio of 1:1 decreases coagulopathy problems, allows cessation of the bleeding quicker and allows less blood to be used. FFP is cheap and low risk so throw it at them

[SMW]

By "plasma expanders" are you referring to non-blood products such as Hetastarch?  These type of products can interfere with coagulation so perhaps that is what is meant/seen as a complicating factor for the surgical procedures.

[mpmiola]

By "plasma expanders" are you referring to non-blood products such as Hetastarch?  These type of products can interfere with coagulation so perhaps that is what is meant/seen as a complicating factor for the surgical procedures.

Yes, no blood products. But, as this product becomes dangerous?

still ...

The RBCs keep her waiting in the emergency room is an acceptable practice?

Should not be in the transfusion service in the form of immediate dismissal?

[mpmiola]

You wouldn't want to be using group O plasma - would need to be group AB...

Recent studies show blood:plasma at a ratio of 1:1 decreases coagulopathy problems, allows cessation of the bleeding quicker and allows less blood to be used. FFP is cheap and low risk so throw it at them

Without knowledge of the patient's ABO group certainly AB plasma. Medical protocol in the plasma be transfused after setting ABO patient while concentrates transfused erythrocytes.

You have to reference the recent study, 1:1, quoted?

[mpmiola]

We use group O Pos (unxm) for all traumas except females <50 yrs old.

transfusion "O +", is not very risky when it becomes routine in several services in trauma care.

We do this in the absence of "O-"

[David Saikin]

 

transfusion "O +", is not very risky when it becomes routine in several services in trauma care.

We do this in the absence of "O-"

 

Studeis show the sensitization rate is very low (~2% I believe).  We have a very limited supply of all blood types (24 bed level 3 trauma).  Our O= would be gone in a flash so that is also part of the reasoning.  If you are going to have a MTP it is best to transfuse plasma products concurrently with rbcs for the best results - or so I have read (my plasma inventory is more meager than my rbcs).  And don't forget a platelet pack every now and then if you have them.