Frankel et al developed a nomogram that can help to identify how likely a patient undergoing a hepatic resection will require blood transfusion. A patient who is more likely to require blood transfusion may benefit from normovolemic hemodilution. The authors are from Memorial Sloan-Kettering Cancer Center in New York City.
Patient selection: hepatic resection without a list of comorbid conditions (Table 1, page 211)
Parameters:
(1) number of segments resected (from 0 to 6)
(2) diagnosis (primary liver disease vs other)
(3) extrahepatic organ resection (such as colon for colorectal carcinoma)
(4) platelet count in 10^3/µL (LOG10)
(5) hemoglobin in g/dL
|
Parameter |
Finding |
Points |
|
number of segments resected |
0 |
0 |
|
|
1 |
7 |
|
|
2 |
14 |
|
|
3 |
21 |
|
|
4 |
30 |
|
|
5 |
43 |
|
|
6 |
55 |
|
diagnosis |
primary |
8 |
|
|
other |
0 |
|
extrahepatic organ resection |
0 |
0 |
|
|
1 |
12 |
|
Hemoglobin |
Points |
|
> 20 |
0 (may not undergo surgery) |
|
7 to 20 |
(-5.346 * (hemoglobin)) + 106.92 |
|
< 7 |
70 (probably transfused) |
|
LOG10 (platelet) |
Points |
|
< 1.6 |
100 (excluded) |
|
1.6 to 2.4 |
(142.3 * ((LOG)^2)) - (694.3 * (LOG)) + 846.8 |
|
2.4 to 3.1 |
(144.6 * ((LOG)^2)) - (704.2 * (LOG)) + 857.4 |
|
> 3.1 |
64 (may not undergo surgery) |
where:
• One of the exclusion criteria was a platelet count < 100,000 per µL (LOG10 = 2).
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: > 200
• The higher the score the greater the likelihood of being transfused.
|
Total Score |
Probability of Being Transfused |
|
0 to 27.9 |
< 10% |
|
28 to 75 |
(0.00859 * ((points)^2)) - (0.1719 * (points)) + 3.788 |
|
75 to 122 |
(0.008939 * ((points)^2)) + (2.607 * (points)) - 94.69 |
|
> 122 |
> 90% |
Specialty: Clinical Laboratory, Surgery, general, Anesthesiology, Emergency Medicine, Critical Care
