Blood Conservation Strategies
OVERVIEW
- Anemia and blood transfusion is common in the critically ill, and are associated with costs and morbidity/ mortality
- Blood testing in the ICU is often excessive and unnecessary and contributes to increased costs and morbidity
STRATEGIES FOR BLOOD CONSERVATION
Blood sampling
- rationale approach to blood testing
- closed system blood sampling (risk of arterial embolism)
- use of point-of-care microsampling
- use of small volume sampling devices
Prevention and treatment of anaemia
- use of appropriate transfusion triggers
- treatment of underlying cause of anaemia (e.g. iron, folate, treat underlying cause)
- avoid bone marrow suppressing agents
- consider erythropoietin
- optimise nutrition
- appropriate blood sampling (see above)
Limit acute blood loss
- find and stop bleeding early
- correct coagulopathy (e.g. hemostatic resuscitation)
- autotransfusion and cell salvage
- consider blood substitutes (modified haemoglobins, perfluorocarbons)
References and links
CCC Transfusion Series
Blood Products: Cryoprecipitate, Fresh Frozen Plasma (FFP), Platelets, Red Cells (RBCs)
>>> Factor Concentrates: Prothrombinex, Factor VIIa, Fibrinogen Concentrate
Reversal Agents:
>>> Rivaroxaban / Apixaban / Enoxaparin: Andexanet Alfa, Rivaroxaban and Bleeding
>>> Dabigatran: Idarucuzimab, Dabigatran and bleeding
>>> Heparin: Protamine
>>> Warfarin: Vitamin K, FFP, PTx, Warfarin Refersal, Warfarin Toxicity
Testing: Coagulation Studies, TEG / ROTEM (Thromboelastography), Platelet function assays
Conditions: Acute Coagulopathy of Trauma, Disseminated Intravascular Coagulation (DIC), Massive Blood Loss
General Topics: Blood Bank, Blood Conservation Strategies, Blood Product Compatibilities, Blood Transfusion Risks, Massive Transfusion Protocol (MTP), Modifications to Blood Components, Procedures and Coagulopathy, Storage Lesions, TRALI, Transfusion Literature, Transfusion Reactions
Journal articles
- Barie PS. Phlebotomy in the intensive care unit: strategies for blood conservation. Crit Care. 2004;8 Suppl 2:S34-6PMC3226149.
- Page C, Retter A, Wyncoll D. Blood conservation devices in critical care: a narrative review. Ann Intensive Care. 2013 May 28;3(1):14. PMC3673809.
- Tinmouth AT, McIntyre LA, Fowler RA. Blood conservation strategies to reduce the need for red blood cell transfusion in critically ill patients. CMAJ. 2008 Jan 1;178(1):49-57. PMC2151112.
FOAM and social media
ICN — Podcast 110. Thomas on Blood Conservation (2013)
[cite]
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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