Sandbox/22

General Approach

Characterize the symptoms: ❑ Low red blood cell count or low hemoglobin level ❑ Difficulty concentrating ❑ Difficulty sleeping ❑ Dizziness ❑ Easy fatigability ❑ Headache ❑ Pale skin ❑ Rapid heart beat ❑ Shortness of breath ❑ Low white blood cell count ❑ Abnormal bleeding ❑ Fever ❑ Irritability ❑ Neurasthenia ❑ Recurrent infections - canker sores, gingivitis, periodontitis ❑ Low platelet count ❑ Blood in urine or stool ❑ Easy or excessive bruising ❑ Heavy menstrual flow ❑ Prolonged bleeding during surgery or after dental work ❑ Prolonged bleeding from cuts

Obtain a detailed history: ❑ Review medical records ❑ Past medical history ❑ Previous blood transfusion ❑ Cardiovascular disease ❑ Hypertension ❑ Arryhthmias ❑ Trauma ❑ Previous Surgery ❑ Infections e.g., HIV ❑ Malignancy ❑ Chronic kidney disease ❑ Chronic lung disease ❑ Medications - anticoagulants, thrombolytics

Examine the patient: ❑ Vital signs: ❑ Blood pressure: ↓ ❑ Pulse rate: ↑ or ↓ ❑ Respiratory rate: ↑ or ↓ ❑ Oxygen saturation: ↓ (<90%) ❑ Temperature: ↑ or ↓ in sepsis ❑ Skin: ❑ Pallor ❑ Jaundice ❑ Petechiae, ecchymosis ❑ Active bleeding ❑ Central nervous system: ❑ Altered sensorium ❑ Personality changes ❑ Lungs: ❑ ❑ Abdomen: ❑ Abdominal distension ❑ Abdominal tenderness

Order laboratory tests (Routine): ❑ CBC ❑ Serum electrolytes ❑ BUN, creatinine ❑ PT/PTT ❑ Type and screen (when transfusion is unlikely) ❑ Type and crossmatch (if transfusion is certain) ❑ ABO blood group system#ABO AntigensABO antigens and antibodies ❑ Rhesus (D) antigen ❑ Antibodies to red cell antigens (antibody screen) Note - Send fresh samples whenever a second transfusion is required Other additional laboratory tests to determine etiology: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑

Pre-transfusion preparation: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑

Low hemoglobin level

Coagulopathy

Low platelets

Coagulation factor deficiency

Indications

Indications

Indications

Consider fresh frozen plasma

Consider cryoprepitate

Consider prothrombin complex concentrate