“Rationalis” – The Rational Use of Blood
In the arena of patient blood management, evidence continues to highlight the need for more restrictive transfusion practice over a broad range of clinical subspecialties. As Dr. Chaplin stated so eloquently in the article quoted above, we must be thoughtful when considering our medical decisions to transfuse, avoiding potential harm to patients.
Of course, we are all aware that there are clearly situations where transfusion may be lifesaving; in particular when exsanguinating hemorrhage occurs. To this end, current literature speaks to the need for well-thought, well-orchestrated protocols to provide effective and efficient transfusions.
The interesting turn of phrase, “rational use of blood”, as noted in the quote, has particular meaning for us as we move forward drafting, educating, implementing and drilling with massive hemorrhage protocols. Indeed, the word “rational” has its origin from the Latin word “rationalis” meaning “pertaining to reason”. And the word also is a derivative of this same Latin root meaning “reason or calculation”.
This idea of ratios which make provision of increased use of plasma and platelets as part of transfusion protocols has been validated in several studies, certainly the PROMMPT and the recent PROPPR trials being two of the most robust.¹ ² Thus, it is incumbent upon us to use meaningful reasons and calculation in applying these ratios to develop the appropriate “mix” of components to treat bleeding patients. There are some subtle arguments as to the best ratio, timing of component therapy, need for pharmaceutical adjuncts etc., however, I believe the basic science research, as well as the trials, show a need for incorporation of plasma and platelets sooner rather than later. I believe we can all agree that trauma, non-trauma, and obstetric patients, although having some differences in the pathophysiology of their hemorrhage, all benefit from the addition of a more balanced resuscitation.
Most important, once protocols are implemented and become a part of our everyday practice, we must remember to review each individual case, evaluating the effectiveness of the intervention(s) and the patient outcome. This is the only manner by which we can continue to assess ourselves and our protocols, to “…prevent transfusion from becoming a thoughtless habit…”
1. Holcomb J et al. JAMA Surg 2013; 148: 127-136
2. Holcomb J et al. JAMA 2015; 313: 471-482
Author: Carolyn Burns, MD