Phys Clinical Cases · haematological
Transfusion Medicine — DCE Clinical Case
DCE long-case station: major gastrointestinal haemorrhage on apixaban — resuscitation, massive transfusion reasoning, reversal and anticoagulation resumption, with presentation template and probing questions.
2 min readVerification in progress
On this page
Study tools
Target exams
FRACP DCEMRCP Part 2
Prompt
DCE long-case station: major gastrointestinal haemorrhage on apixaban — resuscitation, massive transfusion reasoning, reversal and anticoagulation resumption, with presentation template and probing questions.
Focused history — what you must establish
- Bleeding trajectory: onset, volume and frequency of melaena, any haematemesis, syncope, exertional symptoms before collapse [1].
- Anticoagulation detail: agent, dose, adherence, last dose taken; indication (AF stroke risk, prior embolism, mechanical valve exclusion).
- Bleeding diathesis modifiers: NSAIDs, antiplatelets, alcohol, liver disease, previous GI bleeding, known ulcers or varices.
- Comorbidity that changes transfusion tolerance: ischaemic heart disease, heart failure, CKD — these change both the risk of under- and over-transfusing.
- The patient's frame: understanding of his anticoagulation, and his priorities for what comes next.
References2ShowHide
- [1]Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial JAMA, 2015.PMID 25647203
- [2]Carson JL, Guyatt G, Heddle NM, et al. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage JAMA, 2016.PMID 27732721