Weber developed a model for predicting if a patient undergoing surgery for a head and neck cancer will require transfusion. The author is from the University of Texas M.D. Anderson Cancer Center.
TPRA = transfusion prediction and risk assessment model
Patient selection: age from 18 to 74 years
(1) stage of tumor
(2) type of surgery planned
(3) preoperative hemoglobin
below normal Hgb
after Figure 2, Weber (1995), page 13
• The lower limit for hemoglobin in the study was 14 g/dL for males and 12 g/dL for females.
• The lower limit for reference range for hemoglobin in g/dL by age (Tietz, page 314) are:
18 - 44 years
45 - 64 years
65 - 74 years
transfusion unlikely (consider clot and hold)
perform a type and screen
expect transfusion; perform type and crossmatch
Prepare for Transfusion:
(1) Options: preoperative autologous blood donation and/or crossmatch
(2) If the preoperative hemoglobin is >= 11 g/dL, then autologous donation may be sufficient.
(3) If the preoperative hemoglobin is < 11 g/dL, then the patient may not be a candidate for autologous donation. A type and crossmatch is usually necessary.
(1) preoperative hemoglobin
(2) cancer T stage
(3) flap used or not
normal or above
T1 or T2
T3 or T4
= (1.71 * (points for hemoglobin)) + (0.775 * (points for stage)) + (2.12 * (points for flap)) – 3.909
probability of transfusion =
= 1 / (1 + EXP((-1) * X))
If the risk of transfusion is low, then no blood bank orders are indicated.
If the risk of transfusion is 5 to 19%, then a type and screen is indicated.
If the risk of transfusion is >= 20% then blood should be available (either type and crossmatch or preoperative autologous blood donation).
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Purpose: To predict the need for transfusion in patients having surgery for cancer of the head and neck based on preoperative findings.
Specialty: Clinical Laboratory, Surgery, general, Anesthesiology, Emergency Medicine, Critical Care
Objective: severity, prognosis, stage, complications, options, selection
ICD-10: C00-C14, C47.0, C49.0, C76.0, C77.0, C79.3, C80,