PBM: Tidbits

 

UNFINISHED

 

·         Epo + active cancer -> stroke and death

·         Epo + PHx cancer -> cancer recurrence

·         Iron replenishement improves function in heart failure

·         Risk of TACO in heart failure. Give 1 at a time.

·         Anaemia in cancer is multifactorial

·         If iron defiency anaemia and getting blood anyway, still give IV iron

·         If iron deficient and getting Epo, should get iron too.

 

·         Hypothermia: definitely address.

·         Avoid excessive venous pressure at surgical site by appropriate positioning

·         Induced hypotension mAP 50-60 for radical prostatectomy or major joint replacement

·         TEG: consider for cardiac

·         Routine FFP in coagulopathy incl liver disease is not recommended

·         Coag tests in liver disease do not correlate with bleeding risk

·         Prophylactic FFP in cardiac: not recommended

·         Prophylactic platelets in cardiac: not recommended

·         Prophylactic or routine rF7a: not recommended – risk of thrombotic events

·         rF7a: use if everything else has failed – surgery, txa, blood products,

·         Routine cryo or fibrinogen concentrate in medical patients with coagulopathy is not advised. Get haem help with DIC.

 

Critically ill:

·         Restrictive is best

·         Routine FFP for coagulopathy not recommended. Independnetly associated with ARDS and TRALI.

·         INR <2 may not benefit from FFP.

·         Trauma: TXA within 3 hours

·         Critically ill with upper GI bleeding: consider TX

·         Late admin of TXA is probably harmful

·          

 

Obstetrics:

·         Make sure iron replete

·         Group and hold in early preg for all

·         Group and hold early in admission if antibodies

 

Paeds:

 

Need guidelines:

·         Hb reference range

·         Volume

·         Rate

·         Infusion device – pump

·         Monitoring

·         Recognition and reporting of AEs