Transfusion ratios

[deleted875186]

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so I’ve had several instances were the surgery service wants 1-1-1 ratios for trauma patients in the ICU when they are no longer being massively transfused ad not actively bleeding (this is in the ICU, not the OR). For example, the trauma patient who still requires maybe 1 PRBC per day but is stable, blood counts just slowly downtrend over the day. What do you all think. My inclination is this is stupid, especially when all Coags or TEG or fibrinogen are all normal, why expose the more blood products. Is there something I am missing?

If it was in the OR and you had to give 1-2 units, would you give other products with it or just check coags?

 

[Psai]

Blood only, I see no reason to give anything else especially if teg is normal and they have a working liver.

 

[Mman]

If I'm giving a single unit of blood to an otherwise stable patient that isn't coagulopathic and isn't bleeding and the surgery service wants them to get FFP and platelets, I'd tell them they are welcome to do so in the ICU afterwards.

 

[deleted592694]

From the original post:

"(this is in the ICU, not the OR)"

If I'm giving a single unit of blood to an otherwise stable patient that isn't coagulopathic and isn't bleeding and the surgery service wants them to get FFP and platelets, I'd tell them they are welcome to do so in the ICU afterwards.

 

[psychbender]

"Feel free to transfer to another ICU."

Sent from my SM-G930V using SDN mobile

 

[drmwvr]

Surprised the blood bank isn't rioting...ours chafes at sending standby coolers of cross matched units for open AAA's.

 

[MoMoGesiologist]

If I'm giving a single unit of blood to an otherwise stable patient that isn't coagulopathic and isn't bleeding and the surgery service wants them to get FFP and platelets, I'd tell them they are welcome to do so in the ICU afterwards.

How do your surgeons respond when you tell them you won't satisfy their silly requests?

 

[deleted87051]

Maybe the surgeons really want to give whole blood but have only components available. If the patients need volume, they do look a whole lot better after they get blood components instead of crystalloid.

 

[vector2]

Giving 1:1:1 for slow trickle ICU anemia in the absence of abnormal coags/TEG is *****ic and I've never seen that done in any of the ICUs at the three institutions I've been at. Giving allogeneic plasma and platelets without ongoing major hemorrhage to an INR 1.2 and plt count 120 borders on malpractice.

 

[Mman]

How do your surgeons respond when you tell them you won't satisfy their silly requests?

I've literally never had the request in this thread. For other things if we are quibbling I will explain my reasoning and listen to theirs and do what I feel is best for the patient.

 

[dingdong28]

As a blood banker, this seems rather wasteful, especially if the plt count and coags are fine (I know I'm not an anesthesiologist/physician). I will not question a transfusion order unless it is absolutely ridiculous, seems unnecessary and wasteful (our ED will order emergency release units for patient's with a 14/42 hgb/hct and realize they don't need it anymore. of course the temperature of the bag is >10 C and now we have to trash it). If I was working in your hospital's blood bank, I would probably question the need for the FFP and platelets (especially with normal values) since getting these products may not always available right away and can delay the start of the transfusion, or if we had another patient in the ICU/ER/OR that actually needs these products transfused. Bags of apheresis platelets are around $1200 and aren't always in stock at most blood banks since there's a constant shortage of them. FFP takes about 35 - 45 minutes to thaw and process (depending on how fast your bb tech is). Let's not forget that getting additional units from the ARC or other blood centers can take hours for them to ship and receive into the lab, followed by additional set up for the patient.

I know I didn't contribute much to the OP but hopefully this insight from a blood banker helps. Thanks for reading!

 

[pgg]

I know I didn't contribute much to the OP but hopefully this insight from a blood banker helps. Thanks for reading!

It's always great to have input from outside our specialty. Welcome.

 

[deleted875186]

I’ve had multiple surgery services give the ridiculous advice of “we recommend transfusion 1:1:1” when there is absolutely no indication. I don’t push back, but maybe I should. I do think it’s an incessant risk with getting more blood products.

 

[anbuitachi]

I’ve had multiple surgery services give the ridiculous advice of “we recommend transfusion 1:1:1” when there is absolutely no indication. I don’t push back, but maybe I should. I do think it’s an incessant risk with getting more blood products.

well if you dont push back, do you do it?
cause i also think its a risk to patients, getting unnecessary blood products.

 

[deleted875186]

well if you dont push back, do you do it?
cause i also think its a risk to patients, getting unnecessary blood products.

Usually no. The primary team asked me specifically to give FFP to their patient a couple weeks ago and I did, because it’s their patient and they have been very clear that they wanted to micromanage things with the same patient in the past.

Part of the reason (among others) why I decided not to do critical care, even though I really do like the ICU.