Dosering av trombocytt- og erytrocyttkonsentrater- tid for nytenkning ?. Tor Hervig Avdeling for immunologi og transfusjonsmedisin, Haukeland universitetssykehus. Disposisjon. Innledning Dosering av trombocyttkonsentrater Dosering av erytrocyttkonsentrater Oppsummering
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Dosering av trombocytt- og erytrocyttkonsentrater- tid for nytenkning ?
Avdeling for immunologi og transfusjonsmedisin, Haukeland universitetssykehus
(Ola var fra Sandefjord: “Det gikk på engelsk og norsk, engelsk og norsk)
Oksygen til vevene
Celler til å presse trombocyttene mot karveggen
Hva er ønsket hb etter transfusjon?
To store randomiserte studier pågår
Andreas Greinacher, personlig meddelelse
A randomized controlled trial comparing standard- and low-dose strategies for transfusion of platelets (SToP) to patients with thrombocytopenia
Nancy M. Heddle, Richard J. Cook, Alan Tinmouth, C. Tom Kouroukis, Tor Hervig, Ellen Klapper, Joseph M. Brandwein, Zbigniew M. Szczepiorkowski, James P. AuBuchon, Rebecca L. Barty, and Ker-Ai Lee, for the SToP Study investigators of the BEST Collaborative
OPTIMIZING STANDARDS FOR TRANSFUSION OF RED BLOOD CELL CONCENTRATE
Håkon Reikvam and Tor Hervig
Haukeland University hospital and University of Bergen, Norway
Chris Prowse, Products and Components R&D Group, National Science Laboratory, SNBTS, Edinburgh, UK
Nancy M. Heddle, Department of Medicine, McMaster University, Hamilton, ON, Canada
An important approach to the goal of reducing number of transfusions, is to give each patient the most exact hemoglobin (Hb) dosage which is needed to achieve the wanted post-transfusion Hb.
Unfortunately, the Hb content of the units does not represent a homogeneity.
The blood volumes of the patients vary significantly
The term “unit” is derived from the time when “one unit of whole blood” referred to the source, i.e. a whole blood donation
Sweeney JD: Standardization of the red cell product.
Transfus Apher Sci 2006, 34(2):213-218.
As high as a 50-percent difference in Hb content can be encountered between two units (40-60g)
Indicating that RBC transfusions should be based on Hb content of the products instead of units.
Gorlin J, Cable R: What is a unit?Transfusion 2000, 40:263-265.
Arslan O, Toprak S, Arat M, Kayalak Y: Hb content-based transfusion policy successfully reduces the number of RBC units transfused. Transfusion 2004, 44(4):485-488.
Hemodynamically stable patients needing “pop-up” transfusions
Measure hemoglobin content in red cell concentrates
Measure height and weight of patients -> calculate blood volume
Record pre- and post transfusion hemoglobin concentration
To evaluate feasibility (practicability) of such procedures
To evaluate if there is correlation between hemoglobin transfused and hemoglobin increment in patients – per litre of estimated blood volume
Body surface was calculated by method described by DuBois
BSA (m2) = Weight (kg)0.425 x Height (cm)0.725 x 0.007184
Hemoglobin measurements were not causing a lot of extra work
In the laboratory: Sterile docking of sample bag; transfer to test tube, hemoglobin measurement
By just measuring the weight of each unit, correlation and calculation of the actually Hb content in each unit can easily be done.
Planning a large randomized study on hemoglobin increment after red cell transfusion in Bergen (NORWAY?)
Using the method of :
Targeting hemoglobin concentration after transfusion.
Measuring the weight of each unit
That about qualitative aspects?
Koch CG, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med. 2008;358:1229-1239.