Espinosa Aurora, Seghatchian Jerard
Department of Immunology and Transfusion Medicine, St. Olav's Hospital, Trondheim, Norway.
International Consultancy in Blood Component Quality/Safety Improvement, Audit/Inspection and DDR Strategy, London, England, UK.
Transfus Apher Sci. 2014 Dec;51(3):105-10. doi: 10.1016/j.transci.2014.10.017. Epub 2014 Nov 4.
Despite recent advances in the understanding and treatment of coagulopathy, the management of the bleeding patient remains as a major challenge. Traditionally, the main task of the blood bank has been to guarantee the supply of high quality blood and blood components/products to the hospital. Decisions regarding the use of blood components have always been the clinicians' responsibility, with little active involvement of the transfusion service. In the last years, many hospitals have implemented the use of "acute transfusion packages" for massively bleeding patients and point-of-care (POC) instruments such as TEG and RoTEM for monitoring coagulation status in this patient group. This, in addition to the implementation of patient blood management programs in the hospitals, has led to an increasing involvement of transfusion medicine specialists in transfusion decision making, especially regarding strategies for monitoring and treatment of the massively bleeding patient. This new trend may contribute to a more optimal management and monitoring of the bleeding patient, as POC testing may be used as an early predictor for blood usage. The blood bank should optimise the use of POC testing to provide accurate information in a cost-effective way.
尽管在凝血功能障碍的理解和治疗方面取得了最新进展，但出血患者的管理仍然是一项重大挑战。传统上，血库的主要任务是确保向医院供应高质量的血液和血液成分/制品。关于血液成分使用的决策一直是临床医生的责任，输血服务部门很少积极参与。在过去几年中，许多医院对大量出血患者实施了“急性输血套餐”，并使用了血栓弹力图（TEG）和旋转血栓弹力图（RoTEM）等床旁检测（POC）仪器来监测该患者群体的凝血状态。此外，随着医院实施患者血液管理计划，输血医学专家越来越多地参与输血决策，特别是在大量出血患者的监测和治疗策略方面。这种新趋势可能有助于对出血患者进行更优化的管理和监测，因为床旁检测可作为血液使用的早期预测指标。血库应优化床旁检测的使用，以经济有效的方式提供准确信息。
