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Sat Jan 20 13:46:39 GMT 2007

Why not just go back to whole blood and save on all the processing?

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Hardcastle, Tim, Dr <tch at sun.ac.za>
Sent: Saturday, January 20, 2007 12:46 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: No. of ffp's and when to give

To all

A 1:1:1 ratio of PRBC to FFP to Platelets is the evidence based
recommendation: The international blood transfusion society had agreed on
this at their International Congress held last year in Cape Town, South
Africa - represented by all the leaders in transfusion and some trauma
specialists. Look at the J Trauma Supplement of June 2006 (60(6)) for the
military conference - the summary article says it all. Also see the ISBT
Science Series Sept 2006 (1(1) (Vox Sanguinis affiliated publication) page
180 for an evidence based review which I did, which was submitted in May
last year (before the J Trauma came out) with very similar conclusions.

Our personal approach is that we try a balanced transfusion of components,
not just blood, after the first 2 units of Emergency (uncross-matched) PRBC
- i.e. as soon as we have sent the X-match.

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Ivan Maldonado
Sent: Friday, January 19, 2007 8:49 PM
To: Trauma &amp; Critical Care mailing list
Subject: Re: No. of ffp's and when to give

I just  attended the EAST conference and the military are using 1:1  
in with good results...
On Jan 19, 2007, at 12:20 PM, Ben Reynolds wrote:

> Just my own opinion, but when I'm massively
> transfusing someone (evidence of ongoing high volume
> blood loss, assuming no baseline coagulopathy and that
> the bleeding is surgically correctable) I typically
> give 2 units of FFP for every six units of blood
> transfused.  Once blood is hanging I stop ALL
> CRYSTALLOIDS.  After that (assuming surgical
> hemorrhage is stimied, PRBCs aren't still being poured
> in and that a more measured approach can be taken)
> coagulopathy is managed with thomboelastography.
>
> I read the Gonzalez paper and their data seems
> compelling but doesn't really adequately support their
> recommendations on giving FFP:PRBC 1:1, especially
> during the initial phase of resuscitation.  I have a
> lot of reservations empirically pouring in premium
> products at the expense of potentially worsening
> iatrogenic hyperresuscitation.
>
> Ben Reynolds, PA-C
> Pittsburgh, PA
>
>
>
> --- Joe Nemeth <joe.nemeth at mcgill.ca> wrote:
>
>>
>> still waiting for opinions...
>>
>> see below:
>>
>>>>> joe.nemeth at mcgill.ca 18/01/2007 1:40pm >>>
>>
>> Question/Survey....
>>
>> J Trauma Jan 2007....article from Hermann...
>>
>> who uses 1:1 from the get go? i.e. in the ED/trauma
>> bay...
>>
>> joe
>> Emergency Medicine
>> McGill University
>> Montreal
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No. of ffp's and when to give