Rabbie Burns Day today … okay I know what you’re thinking so we may as well get it out of the way So I Married an Axe Murderer was a great flick – if you haven’t seen it – you should. It featured Mike Meyers in “double-role” as his Scottish Dad [“there’s a Piper Doon!I repeat Piper Doon!” … still get a kick out of that]
But … I digress
The celebration of The Bard’s birthday (January 25th) usually requires a Burns Supper where Haggis is consumed. A common misconception is that haggis is made of blood – not true. It’s sheep heart, liver and lungs and it speaks to me about the cultural universal of generations past making the most of resources. It is with this in mind that I share the following.
Blood and blood products are a commodities that are getting harder to procure.
The “Grey Tsunami” is coming [Baby Boomers] and the burden of disease [e.g. cancer and trauma] is increasing so our need for blood is going up. BUT, younger folks are more likely to NOT be donors and/or more likely to have deferrals due to all sorts of things — travel, tatoos, piercings, etc … So, more folks needing blood and less folks donating blood…. doesn’t sound good does it? [Canadian Blood Services Website]
We received a talk today, on our Massive Transfusion Protocol. Here’s a blog post on this from the guys at LITFL.
We’ve all jumped on the bandwagon. We’ve apparently done a good job of dissemination of knowledge. We have been identifying patients who need MTP and even anticipating patients who might. BUT there’s a costly downside from pushing this button that has been made so easily available to us [thanks to BC for the metaphor].
MTP packs are unfrozen and unsealed and need to be used within 30 minutes or are wasted.
In our center, in the last 6 months we have seen approximately $130, 000 lost in wasted blood product from inappropriate activation of our massive transfusion protocol. WOW!
I think I may have been guilty of doing this myself [e.g. get a ‘heads up’ from the vascular surgeon that the ruptured AAA patient en route is not doing so good … so I do what I was taught … I pull the trigger on the MTP so that it’s there ready to stabilise the patient when he arrives … can’t remember if he ever got it … things were hectic intubating and re-resuscitating the patient … off he went to the OR … did we send the blood up? did we send it back? hmm …]
We discussed possible solutions to the apparent trigger-happiness in our health region.
Changes you can make to your protocol are:
1) Consider getting rid of the “anticipated need” criteria. You need to see the bleeding in front of you before you activate.
2) Consider having a “Gatekeeper” [on call person who helps to decide whether criteria are being met – or whether you can just start with the usual “O-Neg stat!”]
3) Consider only activating MTP after 4 units [of “O-Neg Stat!”] have been transfused
and … If you goof up … you better be donating blood! [gulp…]
Back to The Ploughman Poet:
In his poem “To a Mouse” (on turning up her nest with the plough) Burns penned these lines which translated include the often quoted famous line:
“The best laid plans of mice and men often go astray”:
But, Mousie, thou art no thy lane,
In proving foresight may be vain;
The best-laid schemes o’ mice an ‘men
Gang aft agley,
An’lea’e us nought but grief an’ pain,
For promis’d joy!