Page 104 - Hospital Authority Convention 2018

Masterclasses
HOSPITAL AUTHORITY CONVENTION 2018

M7.3 Patient Blood Management – from Overseas to Local Practices 16:15 Theatre 2

Transfusion Alternatives
Lau CW
Collection and Recruitment Department, Blood Transfusion Service, Hong Kong
Transfusion is one of the most commonly used treatment forms in modern medicine. However, increasing evidences is
pointing to the risks of allogeneic blood transfusion, including unprecedented infectious risk, allo-immunisation, major
transfusion reactions, and adverse clinical outcomes that prolong hospital stay, result in higher in-hospital mortality, higher
hospital acquired infection, and higher risk of stroke and cardiac attack.

On the other hand, with the emergence of infections and the worldwide problems of an ageing population, there is imminent
threat in maintaining a safe and adequate supply of blood globally. In view of the safety concerns associated with allogeneic
blood transfusion and the challenges of blood supply, WHO announced the worldwide implementation of Patient Blood
Management in 2011. In its concept paper, the two main priorities were to rationalise the use of allogeneic blood and to
establish evidence for transfusion alternatives.
Over the past decade, transfusion alternatives have been put into practice in a large number of clinical trials covering wide
varieties of clinical scenarios to build up evidence of efficacy and safety of their uses. Subsequently, meta-analyses were
performed to demonstrate their uses across multiple clinical trials. Next, evidences were incorporated into clinical guidelines.
Monday, 7 May 2018 In conclusion, the three main elements in managing anaemic and/or bleeding patients are:
Finally, standard of care for anaemic and/or bleeding patients were established, followed by regular audits to compare the
compliances against the standards.

Maximising endogenous red cell production through pharmacotherapy;
Minimising blood loss through pharmacotherapy and various maneuvers; and
Apart from primary blood production disorders, transfusion is considered as an interim means to stabilise patients before the
former two measures come to work.

In the presentation, intravenous iron and intravenous tranexamic acid will be discussed. Many influential papers and updated
guidelines will also be reviewed.

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