Clinic Trial for West China Perioperative Transfusion Score (WCPTS)
Condition: Transfusion Related Complications
Study type: Interventional

Summary: 
      Guidelines for blood transfusion have been issued for years. According to these guidelines,
      red blood cells (RBCs) transfusion should be given when the hemoglobin level is less than
      6g/dL or 7g/dL and is unnecessary when the level is more than 10g/dL. However, in all the
      guidelines, the determination of whether RBCs should be administered when the hemoglobin
      level is in the range of 6~10g/dL is based on the judgment from anesthesiologists or
      surgeons. Index of transfusion trigger for patients with hemoglobin level between 6g/dL and
      10g/dL is necessary and important in clinical practice.

      Based on the aim of blood transfusion that maintain the balance of oxygen supply and oxygen
      consumption, the investigators hypothesize that index of transfusion trigger for patients
      with hemoglobin level between 6g/dL and 10g/dL could be calculated by parameters including
      infusion rate of adrenalin for maintaining normal cardiac output, fraction of inspired
      oxygen, core temperature, and angina. To verify this hypothesis, the investigators present
      West China Perioperative Transfusion Score (WCPTS) for the trigger of transfusion according
      to the patient's history and monitoring parameters, and the investigators design a randomized
      controlled clinical trial to test this score.
    

Detailed description: 
      Surgery and trauma are the most common reasons for major blood loss, and blood transfusion
      provide guarantee for massive hemorrhagic surgery, especially orthopedic, cardiac, liver, and
      gynecologic procedures. On the other hand, blood transfusion is associated with many risks
      including hemolytic and nonhemolytic reactions, transfusion related acute lung injury
      (TRALI), and others. Besides, blood is insufficient worldwide. How to eliminate allogeneic
      blood transfusion is an important part in clinical practice.

      Guidelines for blood transfusion have been issued for years. According to these guidelines,
      red blood cells (RBCs) transfusion should be given when the hemoglobin level is less than
      6g/dL or 7g/dL and is unnecessary when the level is more than 10g/dL. However, in all the
      guidelines, the determination of whether RBCs should be administered when the hemoglobin
      level is in the range of 6~10g/dL is based on the judgment from anesthesiologists or
      surgeons. Index of transfusion trigger for patients with hemoglobin level between 6g/dL and
      10g/dL is necessary and important in clinical practice.

      Based on the aim of blood transfusion that maintain the balance of oxygen supply and oxygen
      consumption, the investigators hypothesize that index of transfusion trigger for patients
      with hemoglobin level between 6g/dL and 10g/dL could be calculated by parameters including
      infusion rate of adrenalin for maintaining normal cardiac output, fraction of inspired oxygen
      for maintaining spO2≧95%, core temperature, and angina.

      Peri-Operative Transfusion Trigger Score, POTTS The initial score is 6. If a patient's
      cardiac output is normal without infusion of adrenalin, his spO2 could be maintained more
      than 95% with FiO2≤35%, his core temperature is less than 38℃, and he has no angina, his
      score is 6.

      If a patient has one or more problems, including his normal cardiac output should be
      maintained by infusion of adrenalin with its rate ≤0.05μg/kg.min, or his spO2 is maintained
      more than 95% with 36~50% FiO2, or his core temperature is between 38℃ to 40℃, or chest pain
      due to exercise,manual labor,or excitement, his score should be added 1 point for each
      problem.

      If a patient has one or more problems, including his normal cardiac output should be
      maintained by infusion of adrenalin with its rate >0.06μg/kg.min, or his spO2 is maintained
      more than 95% with >51% FiO2, or his core temperature is >40℃, or sudden onset of chest pain
      at rest, his score should be added 2 point for each problem.

      The initial POTTS score is 6, and the patient's score is calculated by the sum of each item.

      Score 6：The transfusion trigger is 6g/dL, and the the patient's Hemoglobin level should be
      maintained not less than 6g/dL.

      Score 7：The transfusion trigger is 7g/dL, and the the patient's Hemoglobin level should be
      maintained not less than 7g/dL.

      Score 8：The transfusion trigger is 8g/dL, and the the patient's Hemoglobin level should be
      maintained not less than 8g/dL.

      Score 9：The transfusion trigger is 9g/dL, and the the patient's Hemoglobin level should be
      maintained not less than 9g/dL.

      Score 10 or >10：The transfusion trigger is 10g/dL, and the the patient's Hemoglobin level
      should be maintained not less than 10g/dL.

      For example, if a patient need ≤0.05μg/kg.min adrenalin to maintain his normal cardiac output
      (+1), his spO2 could be maintained more than 95% with FiO2≤35%, his core temperature is less
      than 38℃, and he has sudden onset of chest pain at rest (+2), his POTTS score could be
      calculated as 6 +1 (≤0.05μg/kg.min adrenalin to maintain his normal cardiac output) +2
      (sudden onset of chest pain at rest), and his POTTS score is 9. That means this patient's
      transfusion trigger is 9g/dL, and his hemoglobin level should be maintained above 9 at this
      situation.
    

Intervention name(s): Transfusion trigger based on WCPTS; Maintenance of hemoglobin level more than 10g/dL; Transfusion trigger based on experience
Intervention type(s): Other; Other; Other
Intervention description(s): Determination of whether a patient needs red blood cell transfusion or which hemoglobin level should be maintained is based on WCPTS; The patient's hemoglobin level is maintained more than 10g/dL perioperatively; Determination of whether the patient need red blood cell transfusion or which hemoglobin level should be maintained is based on the physician's experience
Intervention MeSH terms: Chrysarobin
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Transfusion trigger; Hemoglobin level