7/24/2012

Fein’s hematology missions

Reducing Transfusions and Phlebotomy

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