We frequently consent for Blood Transfusion, but what risks do we tell the patients about and how common are those risks?
In anybody who there is suspicion of a non-traumatic haemorrhage arrange an urgent CT Head.
All patients need IV access and U&E, FBC, Coag
If CT confirms PICH (not traumatic, not SAH): –
If anticoagulated with warfarin or NOAC discuss with stroke consultant and Haematologist regarding reversal
If not anticoagulated give Tranexamic acid – 1g in 100mls Saline/Glucose over 10 mins followed by 1g in 250mls Saline over 6 hours.
BP needs to be <150/80 – use labetalol (max 400mg – until BP <160 or HR <50) and GTN infusion
Not all patients with intracerebral bleeds need referral to neurosurgery – you could save yourself and your patient a lot of time and effort!
Those to refer:
- GCS 9-12/15 with lobar haemorrhage
- Isolated intraventricual haemorrhage
- Hydrocephalus on presentation
- Rapid deterioration following arrival (gcs drop by 2 points or more in the motor component)
- Cerebellar bleed
Admit those not going to Neurosurgery to HASU at CRH after discussion with Stroke team
Trust Guidance varies slightly from BNF for those patients over 100kg
Non-Pregnant PE/DVT treatment
|Dalteparin Cr Clearance >29ml/min||Dalteparin Cr Clearance 20-29ml/min|
|Weight (kg)||Dose||Weight (kg)||Dose|
|<45kg||7,500 units OD||<63kg||5,000 units am
2,500 units pm
|45-56kg||10,000 units OD||63-80kg||5,000 units BD|
|57-68kg||12,500 units OD||81-98kg||7,500 units am
5,000 units pm
|69-82kg||15,000 units OD||99-116kg||7,500 units BD|
|83-100kg||18,000 units OD||117-134kg||10,000 units am
7,500 units pm
|101-115kg||10,000 units BD||135-152kg||10,000 units BD|
|116-140kg||12,500 units BD|
|>140kg||15,000 units BD|
- CrCl Calculator – HERE
- CrCl <20ml/min contact haematologist
Pregnant PE/DVT treatment
|<50kg||10,000 units OD|
|50-69kg||12,500 units OD|
|70-79kg||15,000 units OD|
|80-89kg||18,000 units OD|
|90-109kg||20,000 units OD|
|110-124kg||22,500 units OD|
|125-139kg||12,500 units BD
|140-154kg||15,000 units am
12,500 units pm
|155-169kg||15,000 units BD|
- CrCl Calculator – HERE
- CrCl <30ml/min contact haematologist
Bleeding on Dabigatran?
- <C>ABCD – as usual trying to stop bleed
- Bloods: FBC, Clotting, U&E, G&S
- Discuss with Haematologist (esp. if taken within 12-24hr)
- Idarucizumab (PRAXBIND) 5g IV
- Found in Emergency Drug cupboard
- We experienced delay finding as spelt wrong in the catalogue!
Severe pain is the most common reason that patients with sickle cell, will attend the ED. The pain can be agonising (and often underestimated by us), we need to act fast to help ease the symptoms Read more
On rare occasions you may receive a pre-alert, where you want blood available for the patient when they arrive (for example in major haemorrhage). This process has been agreed with transfusion so this can be done safely and responsibly. Read more
You need to be a bit more suspicious and have a lower threshold for investigation than in patients without Known, Suspected OR Previous Malignancy Read more
When giving blood products you need to use the transfusion care pathway.
It can be found on intranet > Policies & Documents Library >Other Systems [green button] > Clinical records repository > Search [title And transfusion] – its only 9 clicks away (and some writing)
For many conditions the patient should be informed to stop driving and inform the DVLA of their condition. It is the patients responsibility to inform the DVLA, and we should encourage them to do so.
[There is a £1000 fine AND the risk of prosecution] Read more