|
Overview :
Dillon et al identified preoperative risk factors associated
with blood transfusion in a patient with a hip fracture. These can help
determine how to allocate blood products for these patients. The authors are
from Adelaide & Meath Hospital and Trinity College Dublin in Ireland.
Mean transfusion trigger used in patients: 7.8 g/dL
Parameters:
(1) age of the patient
(2) admission hemoglobin
(3) location of the fracture
|
Parameter
|
Finding
|
Points
|
|
age of the patient in years
|
<= 75 years
|
0
|
|
|
> 75 years
|
1
|
|
admission hemoglobin
|
>= 12 g/dL
|
0
|
|
|
< 12 g/dL
|
1
|
|
location of the fracture
|
peritrochanteric
|
1
|
|
|
other
|
0
|
where:
• The probability
of being transfused increases with age, from 5% at age 50 to 50% at age 90.
• The
probability of being transfused increases with decreasing admission hemoglobin,
reaching 85% for an admission hemoglobin of 8 g/dL.
total number of risk factors =
= SUM(points for all 3 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 3
• The higher
the number of risk factors the greater the chances of being transfused.
• The authors
recommended doing type and screen if 0 or 1 risk factor is present. For 2 or 3
risk factors they perform a type and crossmatch.
• Only a small
percent of transfused units are administered intraoperatively. Usually these
patients have >= 2 of the risk factors.
|