Guidelines for Complications of Cancer Treatment Vol VIII Part B

Priorities: Restoration of circulation to re-establish adequateperfusion. Haemostasis of visual bleeding points. Integrated care, by appropriate staff Positive patient identification and documentation of care.Resuscitation: Principles of airway management and resuscitation apply.52Arrest visible haemorrhage: replace blood volume byrapid infusion of WARM crystalloids and/or colloidsthrough multiple large bore cannulae.Transfuse preferably fully crossmatched blood, if timepermits, or if irregular antibodies are known to bepresent. Alternatively, if more urgent, uncrossmatchedgroup specific blood should be given if 1/3 of thepatient’s estimated blood volume has been lost. Inextreme emergency use group O Rhesus D negativeblood. O Rhesus D positive blood is acceptable for postmenopausal female and male patients.Avoid hypothermia by using fluid warmers.Laboratory investigations: Arrange for early initial, and serial assessment of FBC;blood gas analysis, blood biochemistry and aCoagulation Screen.Blood group and cross match Packed Cells (8 Units foran adult – pro.rata. for a child). Further crossmatch isnot required after replacement of 1 blood volume (8 Unitsin adults) as the cells by then are unrepresentative.Repeat estimations every 4 hours, or more frequently,after component therapy.