Blood transfusion: summary of NICE guidance

Padhi, Smita; Kemmis-Betty, Sophia; Rajesh, Sharangini; Hill, Jennifer; Murphy, Michael

doi:10.1136/bmj.h5832

Cited by 120 publications

(105 citation statements)

References 1 publication

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“…NICE recommends using restrictive RBC thresholds (70 g/L and a haemoglobin concentration target of 70–90 g/L after transfusion) for patients who need transfusions and who do not have "major haemorrhage", as defined by NICE 95 , or acute coronary syndrome, and that single unit transfusions should be used 95. Evidence for the use of restrictive thresholds in LGIB is limited and there are no randomised data.…”

Section: Blood Transfusionmentioning

confidence: 99%

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Oakland

Chadwick

East

et al. 2019

Gut

233

241

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This is the first UK national guideline to concentrate on acute lower gastrointestinal bleeding (LGIB) and has been commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). The Guidelines Development Group consisted of representatives from the BSG Endoscopy Committee, the Association of Coloproctology of Great Britain and Ireland, the British Society of Interventional Radiology, the Royal College of Radiologists, NHS Blood and Transplant and a patient representative. A systematic search of the literature was undertaken and the quality of evidence and grading of recommendations appraised according to the GRADE(Grading of Recommendations Assessment, Development and Evaluation) methodology. These guidelines focus on the diagnosis and management of acute LGIB in adults, including methods of risk assessment and interventions to diagnose and treat bleeding (colonoscopy, computed tomography, mesenteric angiography, endoscopic therapy, embolisation and surgery). Recommendations are included on the management of patients who develop LGIB while receiving anticoagulants (including direct oral anticoagulants) or antiplatelet drugs. The appropriate use of blood transfusion is also discussed, including haemoglobin triggers and targets.

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Section: Blood Transfusionmentioning

confidence: 99%

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Oakland

Chadwick

East

et al. 2019

Gut

233

241

View full text Add to dashboard Cite

show abstract

“…Based on these recent publications [92,93,95] , 2 relevant RCTs [94,96] , and the SSC 2016 guidelines [17] , the use of the restrictive strategy for stable patients with sepsis is recommended because it is safe, and the age of RBCs does not affect mortality.…”

Section: Red Blood Cell Transfusionmentioning

confidence: 99%

“…The UK National Clinical Guideline Centre's 2015 guidelines on transfusion of red blood cells (RBC) [92] were published by Carson et al [93] . The two major recommendations (both strong with moderate quality of evidence) -based on a thorough systematic review of studies in critically ill patients -are: (1) hemodynamically stable patients should be managed according to a restrictive RBC transfusion approach, in which the threshold for transfusion is a hemoglobin level <7 g/dL (rather than a liberal approach [threshold of hemoglobin <10 g/dL]), and (2) the age of the RBC units to be transfused should be the standard, i.e.…”

Section: Red Blood Cell Transfusionmentioning

confidence: 99%

Update of Sepsis in the Intensive Care Unit

Genga¹,

Russell²

2017

J Innate Immun

113

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Sepsis, the most common cause of admission to an intensive care unit (ICU), has had an increased incidence and prevalence over the last years with a simultaneous decrease in its short-term mortality. Sepsis survivors are more frequently discharged from hospital and often experience long-term outcomes such as late mortality, immune dysfunction, secondary infections, impaired quality of life, and unplanned readmissions. Early recognition and management of sepsis have challenged emergency care and critical care physicians and nurses. New sepsis definitions were produced and the Surviving Sepsis Campaign (SSC) 2016 was updated recently. Although hospital readmissions after sepsis are common, associated risk factors and how to manage patients who survive an episode of sepsis still need clarification. The immune dysfunction caused by sepsis/septic shock is complex, persistent, affects inflammatory and anti-inflammatory systems, and might be associated with long-term outcomes of sepsis. Several randomized controlled trials (RCT) that analyzed new (and old) interventions in sepsis/septic shock are discussed in this review in parallel with the SSC 2016 recommendations and other guidelines when relevant. RCTs addressing incidence, treatment, and prevention of important sepsis-associated organ dysfunction such as the acute respiratory distress syndrome, acute kidney injury, and brain dysfunction are highlighted. Finally, we briefly discuss the need for novel targets, predictive biomarkers, and new designs of RCTs in sepsis.

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“…For the purposes of obtaining informed consent from a patient for the transfusion of allogeneic blood products before transfusion (or after it, when urgently needed), handwritten or computer-generated forms (ideally a separate sheet of paper) should be used that comprehensively includes a detailed outline of transfusion benefits, risks, and alternatives. Both using a system that electronically identifies patients to improve the safety and efficiency of the blood transfusion process and appropriate verbal and written information to the patient and/or carer were also highlighted by the recent recommendations from the National Institute for Health and Care Excellence on blood transfusion [83].…”

Section: Patient-centered Decision Makingmentioning

confidence: 98%

“…Policies and procedures for ordering, dispensing, and transfusing blood components need to comply with available national guidelines [83][84][85]. Indication for transfusion takes into consideration patient specific factors (eg, age, diagnosis, comorbidity), laboratory values (eg, hemoglobin, platelet count, coagulation testing), presence or absence of bleeding, and physiologic factors (eg, oxygenation, hemodynamic status).…”

Section: Patient-centered Decision Makingmentioning

confidence: 99%

Patient Blood Management Bundles to Facilitate Implementation

Meybohm

Richards

Isbister

et al. 2017

Transfusion Medicine Reviews

189

125

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More than 30% of the world's population are anemic with serious economic consequences including reduced work capacity and other obstacles to national welfare and development. Red blood cell transfusion is the mainstay to correct anemia, but it is also 1 of the top 5 overused procedures. Patient blood management (PBM) is a proactive, patient-centered, and multidisciplinary approach to manage anemia, optimize hemostasis, minimize iatrogenic blood loss, and harness tolerance to anemia. Although the World Health Organization has endorsed PBM in 2010, many hospitals still seek guidance with the implementation of PBM in clinical routine. Given the use of proven change management principles, we propose simple, cost-effective measures enabling any hospital to reduce both anemia and red blood cell transfusions in surgical and medical patients. This article provides comprehensive bundles of PBM components encompassing 107 different PBM measures, divided into 6 bundle blocks acting as a working template to develop institutions' individual PBM practices for hospitals beginning a program or trying to improve an already existing program. A stepwise selection of the most feasible measures will facilitate the implementation of PBM. In this manner, PBM represents a new quality and safety standard.

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Blood transfusion: summary of NICE guidance

Cited by 120 publications

References 1 publication

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Update of Sepsis in the Intensive Care Unit

Patient Blood Management Bundles to Facilitate Implementation

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