Guidelines on the intraoperative transfusion of red blood cells: a protocol for systematic review

Abstract

IntroductionA significant proportion of red blood cell (RBC) transfusions are administered intraoperatively; yet there is limited evidence to guide transfusion decisions in this setting. The objective of this systematic review is to explore the availability, quality and content of clinical practice guidelines (CPGs) reporting on the indication for allogenic RBC transfusion during surgery.MethodsMajor electronic databases (MEDLINE, EMBASE and CINAHL), guideline clearinghouses and Google Scholar, will be systematically searched from inception to January 2019 for CPGs pertaining to indications for intraoperative allogenic RBC transfusion. Characteristics of eligible guidelines will be reported in a summary table. The AGREE II instrument will be used to appraise the quality of identified guidelines. Recommendations advising on indications for intraoperative RBC transfusion will be manually extracted and presented to allow for comparison of similarities and/or discrepancies in the literature.Ethics and disseminationThe results of this systematic review will be disseminated through relevant conferences and peer-reviewed journals.Trial registration numberCRD42018111487

Tranexamic acid in patients with complex stones undergoing percutaneous nephrolithotomy: a randomised, double‐blinded, placebo‐controlled trial

“…For haemodynamically stable adult patients, red blood cell transfusion was not indicated until the haemoglobin level was ≤70 g/L [32,33]. In the operative setting, indications for transfusion commonly reported in the non-operative patient have limited transferability [34]. As blood loss haemoglobin concentration can be unpredictable during surgery, limits the feasibility of using only a specific haemoglobin level to guide red blood cell transfusion administration in surgical patients [32,34].…”

“…In the operative setting, indications for transfusion commonly reported in the non-operative patient have limited transferability [34]. As blood loss haemoglobin concentration can be unpredictable during surgery, limits the feasibility of using only a specific haemoglobin level to guide red blood cell transfusion administration in surgical patients [32,34]. Patients with a haemoglobin level of ≤100 g/L associated with hypotension unresponsive to crystalloid and inotropic drugs and visible intraoperative bleeding, one or more units of autologous allogeneic packed red blood cells was transfused to keep the concentration of haemoglobin >100 g/L and restore adequate haemodynamic perfusion and oxygenation of vital organs [32,35,36].…”

Drug-induced thrombocytopenia

“…Эксперты Американского общества клинических онкологов рекомендует проводить ее пациентам без признаков активного кровотечения, когда количество тромбоцитов снижается <10 × 10 9 /л [75]. При некоторых онкологических заболеваниях, таких как колоректальный рак, рак мочевого пузыря и меланома, трансфузия тромбоцитной массы возможна и при более высоком количестве тромбоцитов в крови [76]. Для безопасного оперативного вмешательства количество тромбоцитов должен быть не менее 40-50 × 10 9 /л [77].…”

Efeito do ácido tranexâmico em pacientes com cálculos renais complexos submetidos à nefrolitotripsia percutânea: estudo randomizado, duplo-cego e placebo-controlado

“…156,157 No intraoperatório, no entanto, o uso exclusivo do nível da hemoglobina como parâmetro para indicar a transfusão de hemácias mostrou-se de valor limitado. 157,158 Com a perda aguda de sangue, a concentração de hemoglobina pode ter variação imprevisível e, muitas vezes, valor superestimado. Faz-se necessária, então, uma análise conjunta de parâmetros de micro e macro-hemodinâmica para ponderar a necessidade da transfusão de hemácias.…”

“…Faz-se necessária, então, uma análise conjunta de parâmetros de micro e macro-hemodinâmica para ponderar a necessidade da transfusão de hemácias. 156,158 Portanto, no estudo TrAc, padronizou-se que pacientes com níveis de hemoglobina abaixo de 10g/dL, associados a sangramento visível no intraoperatório e à hipotensão não responsiva à reposição volêmica com cristaloides e/ou drogas ionotrópicas, receberiam a transfusão de uma ou mais unidades de concentrado de hemácias para restaurar os parâmetros da micro e macrohemodinâmica. 139,156,159 Neste cenário, a NLPC foi abreviada e foi realizado tamponamento do trajeto percutâneo com o uso de uma sonda de nefrostomia (Foley 16Fr).…”