Thread by @medpedshosp

And time has come! Rapid Fire - Evidence for parsimonious pRBC, FFP and Platelets. #SHMConverge

Always back to basics! O2 delivery can be enhanced from multiple variables that are independent from Hb levels. #SHMConverge

#SHMConverge - iron deficiency by itself cause adverse outcomes regardless of the presence of anemia.

Hemodilution studies demonstrated that Hb 7g/dL is a safe cut-off value to transfuse. #SHMConverge

#SHMConverge - there is COMPELLING evidence supporting parsimonious cut off values for transfusion.

#SHMConverge The use of 4 or more pRBC is associated w worse patient outcomes!

#SHMConverge - Iron deficiency is defined as TSAT < 20%, Ferritin < 100 ug/L or CHr < 30%

#SHMConverge - @AmerGastroAssn practice guidelines for GI evaluation for iron deficiency anemia. Bidirectional endoscopy is the new rule!

#SHMConverge - IV iron is safe. The reactions occur in less than 1.7% of cases, and most are anaphylactoid.
The reference for the 2nd slide is: Stojanovic S. J All Clin Immunol. 2020.

#SHMConverge - what to do if we have not had time to optimize anemia preoperatively - quad therapy!

#SHMConverge - Up to 60% of times plasma use is inaproppriate.

If INR is < 2 the % of coagulation factors is already > 30%. So little benefit to use for arbitrary INR correction.

#SHMConverge - FFP must be transfused on a weight based dosing! However, be mindful of TACO!

#SHMConverge - in cirrhosis there is a rebalanced coagulation profile.

#SHMConverge What about the patient using warfarin? - use vitamin K!!!

#SHMConverge in patients taking warfarin who are bleeding rather use 4 factors prothrombin complex concentrates - work faster!

#SHMConverge - the @SIRspecialists guidelines for FFP and platelet use are very compelling! #hvc @hvpaa

The @AABB and the British Society of Hematology have compelling guidelines for platelet transfusion cut-off. #SHMConverge

#SHMConverge - @nickmmark has a terrific set of cards with great images. This is about TEG/ROTEM - we use it primordially in cirrhotic patients.