Steven Fein, M.D., MPH Hematology/Oncology Baptist Health South Florida
• • • • • •
Eliminate HIT Minimize use of IVC filters Minimize blood transfusions Evaluate risk/benefit of anticoagulation Save and cure patients with APL Cure patients with leukemia or lymphoma
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Hematology consult for anemia
Fein’s hematology missions • • • • • •
• • • • • •
Eliminate HIT Minimize use of IVC filters Minimize blood transfusions Evaluate risk/benefit of anticoagulation Save and cure patients with APL Cure patients with leukemia or lymphoma
30yo AA woman G2P1 32 wks gestation, PTL c/o fatigue PMH: C section FHx “sickle cell” Exam: comfortable, no resp distress, not tachy
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7/24/2012
Hematology consult for anemia
Hematology consult for anemia
Hematology consult for anemia
What I’m going to discuss
• Unsuspecting patient got RBC against the advice of the hematologist • Doubt she had a chance to discuss risk/benefit profile fil with ith a physician h i i • Most beneficial part of RBC was iron, already receiving but takes time to help • Poor Obstetrician was called at 5am
• • • •
Benefits and risks of blood transfusion BHSF Blood Conservation Program Decreasing transfusions Decreasing phlebotomy
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7/24/2012
What I’m going to discuss • • • •
Benefits and risks of blood transfusion BHSF Blood Conservation Program Decreasing transfusions Decreasing phlebotomy
Transfusions in 2012 Bleeding after trauma or surgery Bleeding after trauma or surgery Acute GI bleed Post‐partum bleeding
Transfusions in 2012 Cancer patients receiving cytotoxic chemotherapy MDS patients receiving palliative treatment Thalassemia major patients
What if you need a transfusion? • Would you accept a transfusion without investigating the risks and benefits? • What qquestions do yyou have about blood? – Reactions? – Infection? – Will it make me heal faster or slower?
Sickle cell disease with life‐threatening complication or refractory pain crisis
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7/24/2012
What does a transfusion do for pt? RBC 250mL, HCT 80%
Pooled plts 6 x (5 x 1010) plts
Pheresis plts 3 x 1011 platelets
Increase Hgb by 1 May last 1-2 weeks Increase plts by 30 May y last 2-3 days y
Benefits of transfusion RBC
Increase plts by 30 May last 2-3 days Platelets
Plasma (FFP)
Iron repletion for iron deficiency Replace lost blood in bleeding pt Supply oxygen-carrying capacity Treat “symptomatic” symptomatic anemia in patients with RBC production prob (or sometimes hemolytic anemia) Stop or prevent bleeding
Decrease PT INR? Plasma
Cryoprecipitate Increase fibrinogen
Stop or prevent bleeding Special circumstances: TTP
10 pooled units
Patients who need platelets • Chemotherapy pts with bleeding or