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Blood Transfusion

Blood Transfusion. Consultant CPD, November 23 rd 2016. Blood is good. Blood is good. DO2 = CO x CaO2. Blood is bad. Pull out Betty! You’ve hit an artery. Blood is bad. Infections Transfusion reactions TRALI TACO Chemical effects due to storage Microcirculation Immunomodulation.

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Blood Transfusion

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  1. Blood Transfusion Consultant CPD, November 23rd 2016

  2. Blood is good

  3. Blood is good DO2 = CO x CaO2

  4. Blood is bad Pull out Betty! You’ve hit an artery

  5. Blood is bad Infections Transfusion reactions TRALI TACO Chemical effects due to storage Microcirculation Immunomodulation

  6. Blood is bad Infections Transfusion reactions TRALI TACO Chemical effects due to storage Microcirculation Immunomodulation

  7. Blood is bad

  8. Happy medium?

  9. Happy medium? Restrictive transfusion The policy of giving blood only when benefits are deemed to outweigh potential risks

  10. Restrictive vs liberal transfusion strategies

  11. Restrictivevsliberal transfusion strategies

  12. The evidence Restrictive vs liberal transfusion strategies 7 key RCTs General / critical care population Cardiac patients [TBI and SAH]

  13. The TRICC study

  14. The TRICC study • LIBERAL • Hb 100 -120 • RESTRICTIVE • Hb 70 -90 • OUTCOMES • Death at 30 days & 60 days, organ failures

  15. The TRICC study • LIBERAL • Hb 107 ± 7 (5.6 ± 5.3) • RESTRICTIVE (2.6 ± 4.1) • Hb 85 ± 7 • P<0.01

  16. The TRICC study

  17. The TRICC study

  18. The TRICC study

  19. The TRICC study

  20. The TRICC study

  21. The FOCUS study

  22. The FOCUS study 2016 pts >50yrs IHD or risk factors Hb <100 ♯ hip

  23. The FOCUS study

  24. The FOCUS study • LIBERAL • Hb >100 • RESTRICTIVE • Hb < 80 or signs & symptoms • OUTCOMES • Death at 60 days or inability to walk >10ft

  25. The FOCUS study

  26. The FOCUS study

  27. The FOCUS study

  28. The FOCUS (2)study

  29. The FOCUS (2) study

  30. The RELIEVE study >55yrs CCM

  31. The RELIEVE study • LIBERAL • Hb>90 (91-110) • RESTRICTIVE • Hb>70 (71-90) • OUTCOMES • Difference in mean Hb, mortality, adverse events, HRQoL

  32. The RELIEVE study

  33. The RELIEVE study No significant difference in mortality or any of the other outcome measures

  34. Ischaemic Heart Disease

  35. IHD pts Am Heart Journal 2011; 162:300

  36. IHD pts • Hospital-acquired anemia was defined as development of new anemia during hospitalization using age, gender, and race specific criteria • Mild – less than normal - >110 • Moderate – 90-110 • Severe - <90

  37. IHD pts

  38. The MINT study

  39. The MINT study STEMI Non STEMI Unstable angina Cardiac catheter Hb<100

  40. The MINT study • LIBERAL • Hb >100 • RESTRICTIVE • Symptomatic • Hb < 80 • OUTCOMES • Death, MI, unscheduled revascularisation

  41. The MINT study

  42. The MINT study

  43. The TRACS study

  44. The TRACS study • LIBERAL • Ht >30 • RESTRICTIVE • Ht >24 • OUTCOMES • Death, severe morbidity (CVS, RS, Renal)

  45. The TRACS study

  46. The TRACS study

  47. The TRACS study

  48. Upper GI bleed pts

  49. Upper GI bleed pts • LIBERAL • Hb 90 -110 • RESTRICTIVE • Hb 70 -90 • OUTCOMES • Death at 45 days, re-bleed, in hospital complications

  50. Upper GI bleed pts No transfusion 51% vs 14%

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