Praiseldy Langi Sasongko

54 Chapter 2 Historical RBC trends Trend/Theme Drivers/Factors Definition Example quote RBC increased demand Increased hemoglobinopathy patients This sub-code describes how hemoglobinopathy patients are increasing, warranting more treatments, and increasing RBC demand. In an absolute way, we give more transfusions because there are more children. But the relative indication for transfusions has not really changed, has not increased. But the absolute number of patients has increased, so that’s why the number of transfusions are increasing. Post-partum hemorrhage This sub-code describes the rise of women hemorrhaging at delivery, thus exposing them to need blood transfusion and increasing demand. But we’re doing a lot more deliveries based on convenience, so a lot more women are getting babies delivered when they want to or when their obstetrician wants to, so there’s more exposure to eutatonic agents...So your uterus doesn’t contract down as it should, and an uncontracted uterus just bleeds (it’s called uterine atony). I think that’s one of the driving forces. The other is C-section rates are increasing. We’re having more placental implantation problems...Then there’s the 3rd factor: morbidly obese pts tend to bleed more... So those are some of the reasons why the hemorrhage rates are going up. Treatment protocol This sub-code describes changes in treatment protocols that warrant more RBCs. We had this international study (TAPS Trial) and it was, in fact, proven that you really need the blood transfusion before you get an operation and THAT is what changed our policy to put everybody on a transfusion before an operation.

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