Transfusion Information
36th Critical Care Congress: Hematological issues in the critically ill
William Dager, PharmD, discusses reversal of anticoagulants and goals for reversal, risks of bleeding on anticoagulants, and anticoagulant strategies. Jeffrey Barletta, PharmD, FCCM, illustrates pharmacokinetic and pharmadynamic considerations and dose-response relationship, pharmagenetic variability, and pharmacokinetic alterations in critical illness. Mary Beth Shirk, PharmD, presents an algorithmic approach to refractory bleeding, focusing on prevention and the phamacologics. Howard Corwin, MD, FCCM, outlines his argument for transfusion and explores the question of how high hemoglobin levels should be in the critically ill patient and what are the associated benefits. Paul Marik, MD, FCCM, offers his opposition to transfusion in most cases, citing a lack of evidence in the available data.
To hear the complete presentation, click here.
36th Critical Care Congress: Issues in Transfusion Medicine in the Pediatric ICU
Scot Bateman, MD, examines the results of a multicenter transfusion survey study on determinants of transfusion and blood loss across pediatric ICUs. Jacques Lacroix, MD, discusses the data from the Transfusion Requirements in Pediatric Intensive Care Units (TRIPICU) study, comparing the impact of liberal and restrictive transfusion protocols and reviewing the outcomes in critically ill pediatric patients. Naomi Luban, MD, addresses the use of audit and decision support to improve transfusion practices and explores safety and cost effectiveness in blood product utilization in the pediatric ICU.
To hear the complete presentation, click here.
Publications
Blood component therapy. Adult Multiprofessional Critical Care Review, 2007.
The massively transfused patient is defined as one who receives more transfused blood than one blood volume in 24 hours or less. A practical definition is receiving one blood volume in 2 hours or less. The most common settings for massive transfusion are trauma and gastrointestinal bleeding.
Coagulation defects are common in massively transfused patients. These can be caused by dilution of the plasma by massive fluid resuscitation or by red cell transfusions. Packed red cell units contain little plasma, and massive replacement of blood volume with packed red blood cells can lead to a dilutional coagulopathy. Patients also may develop a coagulopathy caused by their underlying medical or surgical condition.
Click here to view the entire chapter, Blood Component Therapy.
For more information on caring for critically ill and injured patients, the publication Adult Multiprofessional Critical Care Review is available for purchase from the Society of Critical Care Medicine. Click here for details or to add to your shopping cart.
Pediatrics
Goal-Directed Blood Transfusion Therapies. Current Concepts in Pediatric Critical Care Course.
It seems reasonable and there is some supporting evidence that severe anemia increases mortality and morbidity in critically ill children. There is also some data supporting the point of view that red blood cell transfusion can improve in some patients. The problem is to correctly identify those patients who will benefit from RBD transfusion and to use markers that will help physicians to determine whether RBDC transfusion is truly beneficial for a given patient. The best indicators (the best determinants) of RBC transfusion in critically ill children are their hemoglobin level, the underlying disease (for example, cyanotic heart disease), and the severity of illness.
Click here to view the entire chapter of Goal-Directed Blood Transfusion Therapies.
For more information on caring for the critically ill and injured patients, the publication Current Concepts in Pediatric Critical Care Course is available for purchase from the Society of Critical Care Medicine. Click here for details or to add to your shopping cart.
Critical Connections Articles
Anemia in Critical Care: Prevalence, Pathophysiology, and PreventionCritical Connections, February 2007
Managing Anemia in Specific PopulationsCritical Connections, February 2007
SCCM Pod-66 2007 Congress Special: Furosemide and Albumin in ARDSGregory Martin, MD, discusses some of the topics from his presentation during the 36th Critical Care Congress, "Furosemide and Albumin in ARDS." Dr. Martin is assistant professor of medicine at Emory University in Atlanta, Georgia, and the section head of pulmonary and critical care division at Grady Memorial Hospital where he is also the director of the medical and coronary ICUs.
SCCM Pod-64 2007 Congress Special: Anemia in the ICUHoward Corwin, MD, FCCM, discusses hematological issues and anemia in the critically ill and injured. Dr. Corwin professor of medicine and section chief of critical care medicine at Dartmouth-Hitchcock Medical Center in New Hampshire and presented during the 36th Critical Care Congress on this topic.