Raman et al developed a simple score for evaluating a pediatric patient who receives a red blood cell transfusion related to cardiac surgery. This can help to identify a potentially unnecessary transfusion. The authors are from the Royal Brompton Hospital in London.
Parameters:
(1) type of blood product
(2) blood loss in mL per kg per hour
(3) hemoglobin in g/dL
(4) skin color (cyanotic vs acyanotic)
(5) clinical stability
|
Type of Product |
Loss in mL per kg per hr |
Hemoglobin |
Skin Color |
Stability |
Score |
|
cell salvage |
NA |
NA |
NA |
NA |
0 |
|
pedipak, previous donor exposure |
NA |
NA |
NA |
NA |
0 |
|
other |
> 10 |
NA |
NA |
NA |
0 |
|
other |
5 to 10, increasing |
NA |
NA |
NA |
0 |
|
other |
5 to 10, decreasing |
NA |
NA |
NA |
1 |
|
other |
< 5 |
NA |
NA |
stable |
2 |
|
other |
NA |
< 8 |
acyanotic |
NA |
0 |
|
other |
NA |
< 10 |
cyanotic |
NA |
0 |
|
other |
NA |
< 10 |
acyanotic |
unstable |
0 |
|
other |
NA |
< 12 |
cyanotic |
unstable |
0 |
|
other |
NA |
10 to 11.9 |
acyanotic |
unstable |
1 |
|
other |
NA |
12 to 13.9 |
cyanotic |
unstable |
1 |
where:
• A patient was termed unstable if the patient requires increasing inotropes, requires an FIO2 > 40% (high), or had an arteriovenous oxygen difference > 50%.
Two possible gaps in the table include:
|
Type of Product |
Loss in mL per kg per hr |
Hemoglobin |
Skin Color |
Stability |
Score |
|
other |
5 to 10, steady |
NA |
NA |
NA |
0.5 |
|
other |
< 5 |
NA |
NA |
unstable |
by hemoglobin |
Interpretation:
• A score of 2 indicates a potentially unnecessary blood transfusion.
• A score of 0 indicates an acceptable blood transfusion.
• The scoring may allow for several combinations of loss (rate in mL per kg per hr and clinical status).
Specialty: Clinical Laboratory
