AAGBI guidelines: the use of blood components and their alternatives 2016

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AAGBI guidelines: the use of blood components and their alternatives 2016 - Klein - 2016 - Anaesthesia - Wiley Online Library

Recommendations

1. All patients should have their haemoglobin concentration (Hb) measured before listing for major elective surgery.
2. Patients who are anaemic by the World Health Organization definition (Hb men < 130 g.l−1, women < 120 g.l−1) should be investigated before elective surgery and treated appropriately, and elective non-urgent surgery other than caesarean section should be delayed.
3. Where blood transfusion is anticipated, this and alternatives to transfusion should be discussed with the patient before surgery, and this should be documented.
4. Red blood cells should be transfused one unit at a time, and the patient's Hb should be checked before each unit transfused, unless there is ongoing bleeding or a large deficit that needs correcting.
5. The use of intra-operative cell salvage and tranexamic acid administration should be considered in all non-obstetric patients where blood loss > 500 ml is possible and in traumatic and obstetric major haemorrhage.
6. Blood components should be prescribed for small children by volume rather than number of units.
7. Every institution should have a massive transfusion protocol which is regularly audited and reviewed.
8. Group O red cells for transfusion should be readily available in the clinical area, in case haemorrhage is life-threatening. Group-specific red cells should be available within a very short time (15–20 min) of the laboratory receiving correctly-labelled samples and being informed of the emergency requirement for blood.
9. During major haemorrhage due to trauma and obstetrics, consideration should be given to transfusing red cells and FFP in preference to other intravenous fluid.
10. Patients who continue to actively bleed should be monitored by point-of-care and/or regular laboratory tests for coagulation, fibrinogen and platelet counts or function, and a guide for transfusion should be FFP if INR > 1.5, cryoprecipitate if fibrinogen < 1.5 g.l−1 and platelets if platelet count < 75 × 109.l−1.