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 Release 22.0, Sept. 2008
 
The Medical Algorithms Project
Chapter : ch5. Transfusion Medicine Section : Estimation of Blood Loss and Prediction of Blood Transfusion Needs
  Transfusion Planning Algorithm in Surgical Patients with Cancer of the Head and Neck

  Online Excel Reference
Copyright (c) 2008-2010, Institute for Algorithmic Medicine, Houston, TX, USA. All rights reserved.

Overview :

For patients undergoing surgery for cancer of the head and neck, the need for transfusion can be predicted and planned for using a clinical algorithm.

 

Variables:

(1) stage of tumor

(2) type of surgery planned

(3) preoperative hemoglobin

 

No.

Tumor Stage

Surgery Planned

Preoperative Hemoglobin

Transfusion Rate

1

not T3/T4

no flap

normal hemoglobin

0.02

2

not T3/T4

no flap

below normal Hgb

0.09

3

not T3/T4

flap

normal hemoglobin

0.13

4

not T3/T4

flap

below normal Hgb

0.46

5

T3/T4

no flap

normal hemoglobin

0.04

6

T3/T4

no flap

below normal Hgb

0.18

7

T3/T4

flap

normal hemoglobin

0.25

8

T3/T4

flap

below normal Hgb

0.65

after Figure 2, Weber (1995), page 13

 

where:

• The lower limit for hemoglobin in the study was 14 g/dL for males and 12 g/dL for females.

• The lower limit for reference range for hemoglobin in g/dL by age (Tietz, page 314) are:

 

age

Male

Female

18 - 44 years

13.2

11.7

45 - 64 years

13.1

11.7

65 - 74 years

12.6

11.7

 

Preoperative Planning

 

No.

Transfusion Needs

1

transfusion unlikely (consider clot and hold)

2

perform a type and screen

3

perform a type and screen

4

expect transfusion; perform type and crossmatch

5

transfusion unlikely (consider clot and hold)

6

perform a type and screen

7

expect transfusion; perform type and crossmatch

8

expect transfusion; perform type and crossmatch

 

Prepare for Transfusion:

• options: preoperative autologous blood donation and/or crossmatch

• If the preoperative hemoglobin is >= 11 g/dL, then autologous donation may be sufficient.

• If the preoperative hemoglobin is < 11 g/dL, then the patient may not be a candidate for autologous donation. A type and crossmatch is usually necessary.

 

  References:

Tietz NW. Clinical Guide to Laboratory Tests, Third Edition. WB Saunders Company. 1995. page 314.

Weber RS. A model for predicting transfusion requirements in head and neck surgery. Laryngoscope. 1995; 105 (Supplement 73): 1-17.

 

 
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