All blood counts : a manual for blood conservation and patient blood management / edited by Dafydd Thomas, John Thompson, Biddy Ridler.

Format:

Book

Contributor:

Thomas, Dafydd (Anesthesiologist), editor.

Thompson, John (John Frederick), 1957- editor.

Ridler, Biddy, editor.

Language:

English

Subjects (All):

Blood--Transfusion.

Blood.

Physical Description:

1 online resource (531 pages) : color illustrations

Edition:

First edition.

Place of Publication:

Shrewsbury, England : tfm Publishing Limited, 2016.

Summary:

This book gathers together the collected wisdom of an experienced group of practitioners from the world of blood conservation including surgeons, anaesthetists, haematologists, transfusion specialists, microbiologists, and legal advisors. Topics included are: an historical overview, transfusion-transmitted diseases, changing demographics and the projected impact on blood supplies, who needs transfusion, practicalities and tips - how to do it, the laboratory perspective, haemodilution, intra-operative cell salvage, surgical methods to minimise blood loss, anaesthetic methods to minimise blood loss, pharmacological methods to minimise blood loss, postoperative salvage, postoperative haemoglobin, cancer patients, patient consent and refusal, trauma management, patient ID and documentation, audit/clinical governance, the role of the Hospital Transfusion Team, education, national reports including European Directives, further information. Additional chapters will include pre-operative blood management, near-patient testing, the incidence and relevance of pre-operative anaemia, anaemia management in obstetrics, pre-operative anaemia in orthopaedics, haemostatic sealants, the effect of transfusion in cardiovascular surgery, transfusion alternatives.

Contents:

All Blood Counts: A manual for blood conservation and patient blood management

Title Page

Copyright

Contents

Contributors

Foreword

Chapter 1: Historical perspective

The provision of blood for transfusion

Introduction

Prior to the end of the First World War

After the First World War

Blood grouping

Pre-transfusion matching

Blood donation safety

Conclusions

Checklist summary

References

Chapter 2: Transfusion transmitted infections

Background

What makes a microbial agent important to blood safety?

Which agents are relevant to transfusion?

Viruses

Bacteria

Parasites

Prions

Other 'emerging' infections

Residual risk

Further reading

Chapter 3: Changing demographics - projected impact on blood supplies/Blood Stock Management Scheme (BSMS)

Evidence

How much blood is there?

How much blood do we need?

Where does blood go?

How can we influence blood usage and wastage?

Inventory management by blood services

Inventory management by hospitals

Chapter 4: What patients and the public need to know about blood conservation - and why they need an advocate

How to do it

Involve people before they become patients

Need to know basis

Patient advocacy

Research

Chapter 5: Haemovigilance in 2020?

Observations from the UK haemovigilance system (Serious Hazards of Transfusion - SHOT)

Joint UK haemovigilance

Patient safety

The triangle of care and correct patient ID

Acute transfusion reactions

Acute reactions

Allergic reactions

Anti-D immunoglobulin (anti-D Ig) incidents

References.

Chapter 6: Patient safety

How to prevent errors

Centralised transfusion databases enhance patient safety

Supporting and educating the prescriber when deciding if a patient needs to be transfused

Chapter 7: NICE guidance and blood management

A brief history of NICE

Technology appraisals

Clinical guidelines

Interventional procedures

Medical technologies

NICE guideline on the assessment and management of blood transfusion

Acknowledgement

Chapter 8 Consent for blood transfusion in adults

Evidence (best practice)

Who can obtain consent for transfusion?

Patient capacity to consent

Patient refusal of consent

Advanced decisions (or directives)

The provision of information

How much information to give?

Has the patient understood the information I have given?

Patients where a transfusion has been determined clinically necessary as a 'one-off' procedure

Patients requiring long-term multiple transfusion episodes over an extended period of time (e.g. a patient with thalassaemia)

Patients where it is thought that a transfusion may be required as part of a procedure, e.g. during surgery, but is not definite at the time of pre-procedure consent

Emergency situations where it is not possible to consent the patient pre-transfusion

Chapter 9: Patient consent in children

Best interests

Competence

Background to competence in children

Age, childhood and the threshold of adulthood

Parental responsibility

Consent between the ages of 16 and 18

Consent in children under 16

Refusal of treatment.

Clinical context of consent for blood transfusion in children

Neonates and blood transfusions

Emergencies and the incapacitated patient

Situations where blood transfusions may be refused

Documenting consent

Practical guidance and information

Chapter 10: Using clinical audit to improve transfusion practice

A. Decide on a topic for audit

High risk

High cost

High volume

Local interest

B. Agree the clinical behaviours to be audited, based on evidence-based guidance where possible

Standards

C to G. Agree what data should be collected/fed back to appropriate people

Making a difference

H. Allow some time for the information to be absorbed

Clinical audit and clinical governance

Chapter 11: Who needs transfusion?

What do red cells do?

Why do we transfuse red cells?

Acute blood loss (Table 2)

Recoverable anaemia in a haemodynamically stable patient (postoperative and other anaemias in patients without bone marrow failure) (Table 3)

Bone marrow failure

Thalassaemia

Exchange transfusion

Radiotherapy

Risks of blood transfusion

Chapter 12: Blood stock management from a laboratory perspective

Determining stock levels

Ordering blood products

Rotating of blood stocks

Issuing of blood products

Returning of allocated units to stock

Audit

Specific considerations

O negative red cells

Frozen components

Wastage of products

Chapter 13: Prehabilitation

Pre-operative anaemia

Maintaining tissue oxygen delivery

Nutrition and physical training

Defining pre-operative anaemia.

Hepcidin and functional iron deficiency

Diagnosis of anaemia and iron deficiency

Pre-operative management of anaemia

Minimisation of bleeding risk

Chapter 14: Intra-operative cell salvage

Vascular surgery

Cardiothoracic surgery

Orthopaedics

Obstetrics and gynaecology

Urology

Other areas

Adverse events

ICS and tranexamic acid (TXA)

Chapter 15: Surgical methods to prevent blood loss

General approaches

Reducing blood pressure

Normothermia

Interventional radiology

Minimally invasive surgery and robotics

Cell salvage

Surgical instruments

Lasers

Ultrasound and water jet dissectors

Topical haemostatic agents

Chapter 16: Anaesthetic methods to minimise blood loss

Patient positioning

Tourniquets

Vasoconstrictors

Surgical technique

Thermoregulation

Balanced anaesthesia

Permissive hypotension

Acute normovolaemic haemodilution

Chapter 17: Pharmacological methods for minimising blood loss

Pharmacology of tranexamic acid (TXA)

The efficacy of tranexamic acid in reducing traumatic bleeding

Efficacy of tranexamic acid in reducing surgical bleeding

Efficacy of tranexamic acid in postpartum haemorrhage

Topical use of tranexamic acid

Other areas where tranexamic acid is being trialled

Dose of tranexamic acid

Thrombotic risk

Chapter 18: Postoperative blood salvage

Efficacy of postoperative cell salvage

Safety of unwashed blood.

How to perform postoperative blood salvage

Devices

Device selection

Contraindications and precautions

Actions to be taken

Implications for everyday clinical practice

Recipe for success

Chapter 19: Haemostasis and sealing - the continuum concept

Relevance to blood conservation

Haemostats - an introduction

Types of haemostats in clinical practice

The importance of haemostats and blood transfusion

Fibrin sealants - an introduction

Fibrin sealants - applicability to clinical practice

Safety

Efficacy

Health economic outcomes

Synthetic sealants - introduction and types

Anti-adhesion

Sealants in blood conservation

Portfolio approach to surgical challenges

Chapter 20: Transfusion triggers for blood and blood products: the evidence

Allogeneic red blood cell transfusion

Fresh frozen plasma, platelets, cryoprecipitate and fibrinogen concentrate

Risks associated with blood and blood products

What is the clinical setting?

Is there a need to transfuse?

Old blood or new blood?

What about blood products?

Practicalities

Chapter 21: Trauma-induced coagulopathy

Revision of the classical description of coagulopathy

Drivers of trauma-induced coagulopathy (Figure 1)

Mechanisms of acute traumatic coagulopathy

Systemic anticoagulation via protein C activation

Hyperfibrinolysis

Fibrinogen depletion

Endothelial activation

Platelet dysfunction

Early diagnosis of trauma-induced coagulopathy

Laboratory coagulation screens

Fibrinogen measurement

Point of care - viscoelastic haemostatic assays

Clinical scoring systems.

Surrogate markers of TIC.

Notes:

Includes bibliographical references at the end of each chapters and index.

Description based on print version record.

ISBN:

1-910079-51-0

OCLC:

993066522