Episode 36: Transfusions, Anticoagulants and Bleeding

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 20 September 2013

⏱️ 88 minutes

🔗️ Recording | iTunes | RSS

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Summary

In the first part of this epic 2 part must-hear episode, Transfusions, Anticoagulants & Bleeding, we have the triumphant return of Dr. Walter Himmel (also known as 'The walking encyclopedia of EM') along with Dr. Katerina Pavenski (Head of Transfusion Medicine at St. Michael's Hospital) & Dr. Jeannie Callum (Head of Transfusion Medicine at Sunnybrook Hospital) who will update you on the latest in transfusion indications & risks, managing INRs and how Wararin compares to Dabigatran, Rivaroxiban & Apixaban. They give you the authoritative low down on: Indications for red cell transfusions in different clinical scenarios (GI bleed, cardiac disease, vaginal bleeding etc) and how to give them, Risks of red cell transfusions including Host vs Graft Disease, TRALI & TACO and how to manage them, IV Iron as an alternative to red cell transfusions, Managing INRs: indications for Vit K, Prothrombin Complex Concentrates (Octaplex & Beriplex), adjusting Warfarin Dose, liver patients, and much much more.........

Transcript

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0:00.0	Welcome to Emergency Medicine Cases.com. I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.
0:12.3	In this month's episode number 36 on anticoagulants, transfusions, and bleeding, we have with us Dr. Jeannie Callum, Dr. Caterina Pavensky, and Dr. Walter Himmel.
0:23.3	Dr. Callum is the director of transfusion medicine and tissue banks at Sunnybrook Health Sciences
0:27.8	Center in Toronto and an associate professor of the Department of Laboratory Medicine
0:31.7	and Pathobiology at the University of Toronto. She serves as the sponsor lead for the Ontario
0:36.3	Regional Blood Coordinating Network for Central Ontario and is an active researcher in transfusion medicine.
0:42.6	Dr. Pavensky is the head of transfusion medicine and a medical director of the
0:46.3	blood conservation and therapeutic aphorias services at St. Michael's Hospital in Toronto.
0:51.7	She's an assistant professor in the Department of Pathobiology
0:54.1	and Laboratory Medicine. She's on the board of directors of the Canadian Society for Transfusion
0:58.8	Medicine and is also an active researcher in transfusion medicine. Dr. Himmel is an emergency
1:03.8	physician at North York General, Scarborough General, and Toronto East General Hospitals. He's a world-renowned
1:08.5	speaker in emergency medicine on the topics of stroke, anticoagulants, transfusions, and drug interactions, and the recipient of multiple
1:15.2	teaching awards. It seems to me that almost every emerge shift I do, I'm confronted with an
1:21.0	anticoagulated patient, or a bleeding patient, and or a patient who requires a blood transfusion
1:26.2	who poses a management dilemma.
1:29.0	There's the patient with the intracranial bleed on Debigotran. There's the patient with a
1:33.5	valve replacement with a high INR and a minor bleed. There's a patient with a history of ITP and a
1:38.9	platelet count of 15 who's bleeding, and the list goes on and on and on. It would be easy if there are up-to-date
1:45.1	guidelines to help us manage these patients, but this field is changing so rapidly that it's
1:49.7	hard to keep up, and there's considerable variation in the approach to these problems among
1:53.7	ED docs. With the recent proliferation of new anticoagulants and anti-platelet agents, these
	...

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