|
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.
|