[HSF] A TRALI case

[hgrmd at aol.com]

The problem in not treating a coagulopathy preemptively is that the patient can bleed a hell of a lot in a short time.  If you wait until you are certain the patient is bleeding a lot in the CVICU, and then you finally order products, you are going to end up having a lot more return trips to the OR.
Hal 
 
-----Original Message-----
From: benjamin.bidstrup at bigpond.com
To: OpenHeart-L at lists.hsforum.com
Sent: Fri, 16 Mar 2007 7:53 AM
Subject: Re: [HSF] A TRALI case


Many years ago I was in a big cold country north of the US and was a VP at a big institution. We were discussing use of blood products and how the residents would treat the path form not the patient, e.g. platelets if the count was <100,000 etc. I said do you look at the bleeding? No, they just treated the numbers. Saw same guy about 6 months later and he thanked me for the $avings they had made. They treated the bleeding patient with appropriate products and left the stable dry ones alone. The saving was in the order of several 100K if I recall correctly (and that was in 1990). Who knows what other iatros was avoided. 
 
George Despotis has written about the targeted use of blood products in the same vein. 
 
 
>Hal, lot of patients have abnormal profiles immediately post CPB but >do not need transfusions. How do you differentiate them. 
>Claudia - I was thinking you will take the bait. 
>Prasanna 
> 
>Hgrmd at aol.com wrote: 
>>Ani, 
>> A few provocative statements, I'd say! If you think it's >>uncommon for abnormal coagulation profiles to cause postop >>bleeding, then your experience is significantly different from >>mine. I can't tell you the number of patients I've seen postop >>with thin bloody drainage who stop bleeding once the INR or the >>platelet count has been corrected. 
>> You are absolutely right that ECMO should have been started. >>Unfortunately, the nurse taking care of the patient didn't notify >>me of the deteriorating oxygenation and hemodynamics until very >>late in the course. As soon as I heard what was going on, I ran >>back to the hospital and inserted an IABP. Twenty minutes later, >>the patient coded. Having never seen or heard of TRALI, I thought >>that this must be some sort of cardiac dysfunction. In the >>future, my index of suspicion will always be there, and, of >>course, I'll institute ECMO sooner than later. 
>>Hal 
>> 
>> 
>> 
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-- Ben Bidstrup FRACS FRCSEd FEBCTS 
Consultant Cardiothoracic Surgeon 
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