McCluskey et al developed an index for identifying a patient who is likely to require significant blood transfusion in the first 24 hours after liver transplantation. The authors are from the University Health Network and University of Toronto.
Massive blood transfusion was defined as receipt of >= 6 units of packed RBCs in the first 24 hours from first skin incision for a liver transplant.
Preoperative parameters:
(1) age of the patient in years
(2) hemoglobin in g/dL
(3) International Normalized Ratio (INR)
(4) platelet count in 10^9/L
(5) serum creatinine in µmol/L (not the reported µmol/mL)
(6) serum albumin in g/L
(7) repeat transplantation
|
Parameter |
Finding |
Points |
|---|---|---|
|
age of the patient in years |
<= 40 years of age |
0 |
|
|
> 40 years of age |
1 |
|
hemoglobin |
>= 10 g/dL |
0 |
|
|
< 10 g/dL |
1 |
|
INR |
< 1.2 |
0 |
|
|
1.2 - 2.0 |
1 |
|
|
> 2.0 |
2 |
|
platelet count |
> 70 * 10^9/L |
0 |
|
|
<= 70 * 10^9/L (<= 70,000 per µL) |
1 |
|
serum creatinine |
female and <= 110 µmol/L |
0 |
|
|
female and > 110 µmol/L |
1 |
|
|
male and <= 120 µmol/L |
0 |
|
|
male and > 120 µmol/L |
1 |
|
serum albumin |
> 24 g/L |
0 |
|
|
<= 24 g/dL |
1 |
|
repeat transplantation |
no |
0 |
|
|
yes |
1 |
total risk index =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• The higher the score the greater the risk of requiring significant blood transfusion.
|
Risk Index |
Risk Group |
Risk of Massive Transfusion |
|
0 |
low |
10% |
|
1 or 2 |
intermediate |
20 - 40% |
|
3 to 8 |
high |
70 - 85% |
Purpose: To identify a patient who is likely to require >= 6 units packed RBCs in the first 24 hours associated with liver transplant as reported by McCluskey et al.
Specialty: Clinical Laboratory, Surgery, general, Anesthesiology, Emergency Medicine, Critical Care
Objective: risk factors, severity, prognosis, stage, complications, selection, complication detection
ICD-10: D62, Z51.3, Z94.4,
