Is there any score to predict massive transfusion i.e; >/=5 units RCC in case of GI bleed just like for trauma patients?
Yes, its massive haemorrhage protocol for GI bleed. NHS has clear guidelines for that.
Hi! Don't forget to evaluate their Shock Index (HR/SBP). If greater than approx. 0.7, that is one indication for the need for massive transfusion. We can also look at whether or not the shock is Pressor-dependent. If it requires pressors, that is another worrying sign. When looking at the labs, if the Hgb is *normal* with the heavy bleeding, that is a sign of a very active bleed where the H&H has not yet caught up to display the downward spiral. Activate your Massive Transfusion protocol and also consider Cyroprecipitate, IV Calcium, and warming blankets. Often forgotten. IV TXA is also a good plan.
So the things to look for are
1- 150ml/hr blood loss
2- 2.5L per 12 hours
3- 5L in 24 hours and
4- the shock index (though not a part of NHS algorithm)
TXA has been proved to be less helpful in GI bleed, unfortunately, although its still used in many set ups.
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