Blood Conservation Strategies
- 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
- 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
Cryoprecipitate, Fresh Frozen Plasma (FFP), Platelets, Red Cells (RBCs)
Concentrates: Prothrombinex, Factor VIIa, Fibrinogen Concentrate
Rivaroxaban / Apixaban / Enoxaparin: Andexanet Alfa, Rivaroxaban and Bleeding
Dabigatran: Idarucuzimab, Dabigatran and bleeding
Warfarin: Vitamin K / FFP / PTx, Warfarin Reversal, Warfarin Toxicity
Coagulation Studies, TEG / ROTEM (Thromboelastography), Platelet function assays
Acute Coagulopathy of Trauma, Blood Bank, Blood conservation strategies, Blood Product Compatibilities, Blood transfusion risks, Disseminated Intravascular Coagulation, Massive blood loss, Massive transfusion protocol (MTP), Modifications to blood components,Procedures and Coagulopathy, Storage Lesions, TRALI, Transfusion Literature Summaries, Transfusion Reactions
- 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)
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC