1. In patients with critical bleeding requiring massive transfusion, institutions should develop massive transfusion protocols that include guidelines for the dose, timing, and ratios of blood component transfusions.
2. Key parameters that should be measured early and frequently include temperature, acid-base status, calcium, hemoglobin, platelet count, coagulation factors, and fibrinogen level.
3. While specific transfusion ratios are uncertain, suggested doses of blood components in massive transfusion are 15 mL/kg of fresh frozen plasma, one adult therapeutic dose of platelets, and 3-4 grams of cryoprecipitate.
Autologous Blood Transfusion (ABT) means reinfusion of blood or blood products taken from the same patient
ABT is not a new concept, fear of transfusion- transmitted diseases stimulated the growth of autologous programme
I missed the Critical Care Congress at Pune. Couldn't make it because of certain personal reasons. However, I was to deliver a talk on ROLE OF BLOOD COMPONENTS & rFVIIa IN OBSTETRICS on 21 Jul 13 at 11 am. Feel duty bound to share the presentation with all who wanted to hear it there. I have uploaded it at Slideshare and queries, if any, may be addressed to navneetmagon@gmail.com.
dr m laban
Tanta fever hospital scientific activity
sunday
12-8-2018
Blood transfusion
Aims of Transfusion Center
To care for the donor - ensure act of donation does not harm donor.
Provision of Blood of the best possible quality and safety for the patient receiving it.
Safe blood transfusion means:
Compatible and without transmission of infection
The Safest blood transfusion is No
transfusion
Blood donation
Careful donor selection with donor interview.
Age: not less than 17 years.
Pulse: between 50-100 beat / minute without irregularities.
Blood pressure: systole<180mmHg, diastolic <100mmHg.
Temperature: <37.5C
Hemoglobin:>12g/dl, Hct>38%
Site of vein puncture must be free of lesions and infections.
ABO grouping.
Rh typing.
Cross matching
Laboratory screening test for:-
HBsAg.
HCV Ab.
HIV.
HTLV1.
HTLV2.
Blood grouping means:-
the determination of the antigens of a specific group on the red cells
and the antibodies relevant to this group in the normal serum.
It contains indications of blood and blood products and perioperative blood therapy that we usually follow in Aiims Patna ..its is most recent one made in April 2020
Autologous Blood Transfusion (ABT) means reinfusion of blood or blood products taken from the same patient
ABT is not a new concept, fear of transfusion- transmitted diseases stimulated the growth of autologous programme
I missed the Critical Care Congress at Pune. Couldn't make it because of certain personal reasons. However, I was to deliver a talk on ROLE OF BLOOD COMPONENTS & rFVIIa IN OBSTETRICS on 21 Jul 13 at 11 am. Feel duty bound to share the presentation with all who wanted to hear it there. I have uploaded it at Slideshare and queries, if any, may be addressed to navneetmagon@gmail.com.
dr m laban
Tanta fever hospital scientific activity
sunday
12-8-2018
Blood transfusion
Aims of Transfusion Center
To care for the donor - ensure act of donation does not harm donor.
Provision of Blood of the best possible quality and safety for the patient receiving it.
Safe blood transfusion means:
Compatible and without transmission of infection
The Safest blood transfusion is No
transfusion
Blood donation
Careful donor selection with donor interview.
Age: not less than 17 years.
Pulse: between 50-100 beat / minute without irregularities.
Blood pressure: systole<180mmHg, diastolic <100mmHg.
Temperature: <37.5C
Hemoglobin:>12g/dl, Hct>38%
Site of vein puncture must be free of lesions and infections.
ABO grouping.
Rh typing.
Cross matching
Laboratory screening test for:-
HBsAg.
HCV Ab.
HIV.
HTLV1.
HTLV2.
Blood grouping means:-
the determination of the antigens of a specific group on the red cells
and the antibodies relevant to this group in the normal serum.
It contains indications of blood and blood products and perioperative blood therapy that we usually follow in Aiims Patna ..its is most recent one made in April 2020
Transfusion Medicine has evolved in last decade & many societies have given recommendations for safe transfusion practices. Compiling these recommendations is very useful academic & practical activity
as an oral and maxillofacial surgeon, we should know how to manage a patient with known bleeding disorders in our regular practice to avoid unfortunate incidents
its sometime difficult to decide in urgent clinical scenarios - Trauma,active bleeding, surgery: What ; when ; how and why to transfuse? answering some of these queries here is my presentation especially made for PG students (will help in answer writing)
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
3. A Sad Case
“Names and places have been changed to protect
innocent practitioners involved”
Bedside Critical Care 2012
4. A Sad Case
• 36 yr old dirt bike rider
• Comes off his motorcycle at 80 Km/hr
• Lands with his abdomen over a log
• Attended to by Ambos at the scene
• GCS 15, HR 125 bpm BP 124/68
• +++ abdominal pain
• Given morphine and metoclopramide
Bedside Critical Care 2012
5. Arrives at Gunadulotsa Base Hospital
• GCS 15, but very distressed
• HR 130 bpm BP 105/58
• Features of an acute abdomen
Bedside Critical Care 2012
6. Retrieval Activated
• 3000 ml crystaloid with ongoing background
maintance of 120 ml/hr
• 3 units of PRBC given
• Original Hb returns 146
• Repeat Hb 168
• Progressive respiratory distress
• Intubated, FiO2 0.8
Bedside Critical Care 2012
7. Arrives at Royal Elsewhere’s and
Men’s Hospital
• Full and extensive work up in the emergency
Department
• CT demonstrates a fractured liver and little else
• To OT
• Hb 132
• Plts 105
• INR 1.6
Bedside Critical Care 2012
8. On Return to Intensive Care
• Receives 6 units FFP
• Hb 103
• Transfused a further 2 units PRBC
• Post transfusion Hb 127
• Given tranexamic acid 1 g followed by an
infusion of 1g over 8 hours
• Given 1 bag pooled Platelets
Bedside Critical Care
2012
9. Progress
• Partial hepatectomy fast and effective
• But develops a fever, rising WBC, Bilateral
pulmonary infiltrates and increasing ventilatory
requirement
• Bilateral DVTs on U/S
• After a prolonged ICU admission with a difficult
respiratory wean discharged to surgery with
trauma team input.
Bedside Critical Care
2012
12. Lessons from the Black Box
1. Massive transfusion protocols
2. Transfusion triggers
3. Transfusion ratios
4. The role of Tranexamic acid
Bedside Critical Care
2012
14. National Blood Authority
2001 National Health and Medical Research Council/
Australasian Society of Blood Transfusion
(NHMRC/ASBT)
Clinical practice guidelines on the use of blood components
Now replaced by NBA:
Patient Blood Management Guidelines: Modules 1-6
Bedside Critical Care
2012
15. Patient blood management aims to improve clinical
outcomes by avoiding unnecessary exposure to blood
components
It includes the three pillars of:
1. Optimisation of blood volume
and red cell mass
2. Minimisation of blood loss
3. Optimisation of the patient’s
tolerance of anaemia.
Bedside Critical Care
2012
16. So What is the Utility of Massive
transfusion Protocols?
Bedside Critical Care
2012
17. Recommendation I
It is recommended that institutions develop an
MTP that includes the dose, timing and ratio of
blood component therapy for use in trauma
patients with, or at risk of, critical bleeding
requiring massive transfusion (Grade C)
Bedside Critical Care
2012
18. Practice Point
In patients with critical bleeding requiring
massive transfusion, the use of an MTP to
facilitate timely and appropriate use of RBC and
other blood components may reduce the risk of
mortality and ARDS.
Bedside Critical Care
2012
19. Senior clinician
• Request:a
o 4 units RBC
o 2 units FFP
• Consider:a
o 1 adult therapeutic dose platelets
o tranexamic acid in trauma patients
• Include:a
o cryoprecipitate if fibrinogen < 1 g/L
a Or locally agreed configuration
Massive transfusion protocol (MTP) template
Senior clinician determines that patient meets criteria for MTP activation
Baseline:
Full blood count, coagulation screen (PT, INR, APTT, fibrinogen), biochemistry,
arterial blood gases
Notify transfusion laboratory (insert contact no.) to:
‘Activate MTP’
Bleeding controlled?
Laboratory staff
• Notify haematologist/transfusion specialist
• Prepare and issue blood components
as requested
• Anticipate repeat testing and
blood component requirements
• Minimise test turnaround times
• Consider staff resources
Haematologist/transfusion
specialist
• Liaise regularly with laboratory
and clinical team
• Assist in interpretation of results, and
advise on blood component support
NOYES
Notify transfusion laboratory to:
‘Cease MTP’
OPTIMISE:
• oxygenation
• cardiac output
• tissue perfusion
• metabolic state
MONITOR
(every 30–60 mins):
• full blood count
• coagulation screen
• ionised calcium
• arterial blood gases
AIM FOR:
• temperature > 350C
• pH > 7.2
• base excess < –6
• lactate < 4 mmol/L
• Ca2+ > 1.1 mmol/L
• platelets > 50 × 109/L
• PT/APTT < 1.5 × normal
• INR ≤ 1.5
• fibrinogen > 1.0 g/L
The information below, developed by consensus, broadly covers areas that should be included in a local MTP. This
template can be used to develop an MTP to meet the needs of the local institution's patient population and resourcesBedside Critical Care
2012
20. Bedside Critical Care
2012
So in patients with critical bleeding requiring
massive transfusion, which parameters should
be measured early and frequently?
21. In patients with critical bleeding requiring massive
transfusion, the following parameters should be
measured early and frequently:
1. Temperature
2. Acid–base status
3. Ionised calcium
4. Haemoglobin
5. Platelet count
6. PT/INR
7. APTT
8. Fibrinogen level.
With successful treatment, values should trend towards normal.
Bedside Critical Care 2012
Practice Point
22. Values indicative of critical physiologic
derangement include:
1. Temperature < 35°C
2. pH < 7.2, base excess > –6, lactate > 4 mmol/L
3. ionised calcium < 1.1 mmol/L
4. platelet count < 50 × 109/L
5. PT > 1.5 × normal
6. INR > 1.5
7. APTT > 1.5 × normal
8. fibrinogen level < 1.0 g/L.
Bedside Critical Care 2012
Practice Point
23. So what product ratios should we be
using?
Bedside Critical Care 2012
25. Holcomb JB, Wade CE, Michalek JE, Chisholm GB, Zarzabal LA, Schreiber MA, Gonzalez EA,
Pomper GJ, Perkins JG, Spinella PC, Williams KL, Park MS. Increased plasma and platelet to red
blood cell ratios improves outcome in 466
massively transfused civilian trauma patients. Ann Surg 2008; 248:447-458.
26. Product ratios
• Massive data base ~ 25 000
• 16% transfused
• 11.4% received massive transfusions
• Logistic regression identified the ratio of FFP to PRBC use as
an independent predictor of survival.
• With a higher the ratio of FFP:PRBC, a greater probability of
survival was noted.
• The optimal ratio in this analysis was an FFP:PRBC ratio of
1:3 or less.
Teixeira PG, Inaba K, Shulman I, Salim A, Demetriades D, Brown C,
Browder T, Green D, Rhee P. Impact of plasma transfusion in massively transfusedtrauma
patients. J Trauma 2009; 66:693-697.
27. Practice Point
In patients with critical bleeding requiring
massive transfusion, insufficient evidence was
identified to support or refute the use of specific
ratios of RBCs to blood components.
Bedside Critical Care 2012
28. Practice Point
In patients with critical bleeding requiring
massive transfusion, suggested doses of blood
components are:
1. FFP: 15 mL/kg
2. platelets: 1 adult therapeutic dose
3. cryoprecipitate: 3–4 g.
Bedside Critical Care
2012
30. Practice Point
In patients with critical bleeding requiring
massive transfusion, haemoglobin concentration
should be interpreted in the context of
haemodynamic status, organ perfusion and
tissue oxygenation.
Bedside Critical Care
2012
31. Practice Point
In patients with critical bleeding requiring
massive transfusion, the use of RBC and other
blood components may be life saving.
However, transfusion of increased volumes of
RBC and other blood components may be
independently associated with increased
mortality and ARDS.
Bedside Critical Care
2012
33. Recommendation 2
The routine use of rFVIIa in trauma patients with
critical bleeding requiring massive transfusion is
not recommended because of its lack of effect on
mortality (Grade B) and variable effect on
morbidity (Grade C).
Bedside Critical Care 2012
34. Practice Point
1. An MTP should include advice on the administration of rFVIIa
when conventional measures – including surgical haemostasis
and component therapy – have failed to control critical bleeding.
2. NB: rFVIIa is not licensed for this use. Its use should only be
considered in exceptional circumstances where survival is
considered a credible outcome
3. When rFVIIa is administered to patients with critical bleeding
requiring massive transfusion, an initial dose of 90 μg/kg is
reasonable.
Bedside Critical Care 2012
35. Crash 2
In trauma patients with or at risk of significant
haemorrhage, tranexamic acid (loading dose 1 g
over 10 minutes, followed by infusion of 1 g over
8 hours) should be considered.
No systematic review was conducted on
tranexamic acid in critical bleeding/massive
transfusion. The study population was not
restricted to critical bleeding requiring massive
transfusion.
Bedside Critical Care
2012
38. The routine use of rFVIIa in trauma patients is not recommended due to
its lack of effect on mortality (Grade B) and variable effect on morbidity
(Grade C). Institutions may choose to develop a process for the use of
rFVIIa where there is:
• uncontrolled haemorrhage in salvageable patient, and
• failed surgical or radiological measures to control bleeding, and
• adequate blood component replacement, and
• pH > 7.2, temperature > 340C.
Discuss dose with haematologist/transfusion specialist
b rFVIIa is not licensed for use in this situation; all use must be part of practice review.
• Warfarin:
• add vitamin K, prothrombinex/FFP
• Obstetric haemorrhage:
• early DIC often present; consider cryoprecipitate
• Head injury:
• aim for platelet count > 100 × 109/L
• permissive hypotension contraindicated
• Avoid hypothermia, institute active warming
• Avoid excessive crystalloid
• Tolerate permissive hypotension (BP 80–100 mmHg systolic)
until active bleeding controlled
• Do not use haemoglobin alone as a transfusion trigger
• Identify cause
• Initial measures:
- compression
- tourniquet
- packing
• Surgical assessment:
- early surgery or angiography to stop bleeding
• If significant physiological derangement, consider
damage control surgery or angiography
• Consider use of cell salvage where appropriate
• Actual or anticipated 4 units RBC in < 4 hrs, + haemodynamically unstable, +/– anticipated ongoing bleeding
• Severe thoracic, abdominal, pelvic or multiple long bone trauma
• Major obstetric, gastrointestinal or surgical bleeding
Specific surgical considerations
ResuscitationInitial management of bleeding
Dosage
Cell salvage
Considerations for use of rFVIIab
Special clinical situations
Suggested criteria for activation of MTP
ABG arterial blood gas FFP fresh frozen plasma APTT activated partial thromboplastin time
INR international normalised ratio BP blood pressure MTP massive transfusion protocol
DIC disseminated intravascular coagulation PT prothrombin time FBC full blood count
RBC red blood cell rFVlla activated recombinant factor VII
Platelet count < 50 x 109/L 1 adult therapeutic dose
INR > 1.5 FFP 15 mL/kga
Fibrinogen < 1.0 g/L cryoprecipitate 3–4 ga
Tranexamic acid loading dose 1 g over 10 min,
then infusion of 1 g over 8 hrs
a Local transfusion laboratory to advise on number of units
needed to provide this dose
Bedside Critical Care
2012