Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Blood and blood productsBlood and blood productsBlood transfusion – indications[Dr Mark Porter, January 2006; appraised by Dr Keith Clayton, January 2010]Blood transfusion can bring benefit but also has significant risks andcomplications. Each unit of blood is a scarce resource. In cases ofsignificant expected or actual haemorrhage, arrange for haemoglobinmonitoring to be available using in-theatres testing with HemoCue orarterial blood gas analysis. Remember that there are significantdilutional and rebound effects on the measured haemoglobin level.Do not attempt to manage massive haemorrhage on your own.Discuss potential cases with a senior colleague and call for help if ithappens.In case of acute haemorrhage or when you expect cross-matchedblood to be exhausted: call for senior help, then telephone bloodbank to discuss the patient’s needs. There is emergency ‘O Rh(D)negative’ blood available. Group specific blood (‘red label blood’) willalways arrive more quickly than cross-matched blood.YOU MUST CHECK ALL BLOOD PRODUCTS AGAINST THEPATIENT’S IDENTITY.The identity is recorded on the patient’s armband. You should confirmthe armband information with the patient on admission to theatres ifpossible. Remember to identify the patient positively – ask them tostate their name, date of birth and address, rather than just asking,for example, “Are you Mr Fred Jones?”The following guidelines are appropriate to elective surgery. Theymay be appropriate to urgent surgery but you should considercarefully how the urgent situation could change appropriatemanagement.• Where possible, anaemia should be corrected prior to majorsurgery to reduce exposure to allogeneic transfusion.Anaesthetists Handbook January 2010 177