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Tue Feb 12 22:31:55 GMT 2008

Mike, Tim, Ron et all,

I always try and apply a 1:1 transfusion ratio (and usually succeed in
applying it) at least in the acute phase anyway. The problem happens when
patients go to the ITU and the intensivists (at least in a number of the
hospitals I have worked in anyway) have transfused without applying the 1:1
ratio. Maybe quite a few of us share the same bloodbank but I usually get
round it by saying that, if we don't get the FFP & platelets in the 1:1
ratio now, we will probably end up requesting Factor VIIa from the lab,
which usually encourages them to oblige, not to mention the unnecessary
extra units of packed RBCs which will also inevitably be required.

Tim & Ron are both right in what they say. With a 1:1 ration, less units of
packed RBCs will be required, there will be less incidence of TRALI
(transfusion related acute lung injury), increased immunogenic response
(worsening inflammatory cascade etc.), iron overload, cardiac failure and
overload plus increased post-op ileus (due to more profound intra-mural
bowel wall oedema etc.) all of which contribute to worsening the prognosis
of the trauma patient who is already in extremis physiologically.

Mike - I don't use ANY normal crystalloid in resuscitation (as I ALWAYS
apply permissive hypotension.) If the trauma patient is hypotensive and has
one of the FEW indications for fluid (such as no carotid pulse [i.e. no
cardiac output] or a head injury requiring increased CPP) then they will
either receive blood (if available) or hypertonic (7.2%) saline with
polystarches (if blood is not available.)

The concept behind a 1:1 transfusion protocol clearly makes sense, so I
don't understand why people don't either apply it or agree with the
principle. I do however think that most people on this list will be
advocates of the 1:1 transfusion ethos (including the
anaesthetists/intensivists.) The problem lies with others who are not
like-minded clinicians and do not share the same interest and enthusiasm as
everyone here. Unless I am missing something???

Matthew

-----Original Message-----
From: Ronald Gross [mailto:Rgross at harthosp.org] 
Sent: 12 February 2008 16:16
To: Trauma &amp; Critical Care mailing list
Subject: RE: Who's doing 1:1 blood transfusions for shock?

Mike, Tim, et all,

I think Tim and I have the same blood bank!  We, too, are going to the 1:1:1
more often than not; I do it routinely largely because that is what I was
doing when I was in the sandbox, and because several of my colleagues are
starting to believe, thanks to Holcomb and our early results here.  It has
NOT been universally accepted, however, and I am not sure why.

Ron

>>> "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za> 2/12/2008 11:03 AM
>>>

Mike

We do it as best possible - our blood bank tries their best to make it
difficult. My subjective opinion is that we use less blood in total and have
less abdomens left open after OR due to bowel oedema (same reason we use
modern starches and geletins as resus fluids!!)

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

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 Sise, Mike MD

Sent: Tuesday, February 12, 2008 5:56 PM

To: trauma-list at trauma.org 

Subject: Who's doing 1:1 blood transfusions for shock?

To all,

Who's doing 1:1 fresh frozen plasma to packed RBCs transfusions and limiting
crystalloid for resuscitation in hemorrhagic shock? If you've adopted it -
why? If not - why? Any and all comments requested.

Mike Sise

San Diego

"Scripps Information Security"

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1:1 Blood Transfusions For Shock?