Another excellent vídeo Dra Tala. Thank you so much. One question is what about platelets transfusion on active bleeding..., what range and dose do you use on your unit? Thank you so much again. Follower of your work.
Hello Felipe- we touched on this in one of the earlier platelet videos. I'd say our thresholds fell considerably after this paper was published: www.nejm.org/doi/full/10.1056/NEJMoa1807320 In a baby not bleeding, we'll go down to 25-40K. If the baby is bleeding actively, my numbers are still higher- probably < 100K. Hope this helps?!
I wonder the place that you are working must be a great learning NICU environment. All the NICU staff should be blessed to have a mentor like you Dr. Tala - I wish you were my preceptor during my clinical rotations 😉😉😊
Thank you so much Sady! What a lovely compliment. The truth is we have absolutely fantastic staff in our hospitals- so I think we're probably all really lucky :)
Great video again! You have such a gift! Do you mind sharing what your thresholds are for when you would give FFP (i.e. at or above what PT/PTT level?) Would it depend on whether they are bleeding or how sick they are? Thank you!
Hi JH! So glad you like video- sorry took me a couple of days! Honestly I don’t really have thresholds for PT/PTT. Often I don’t even check it- because takes so much blood. So if an infant is bleeding weirdly then I’ll check it- and if at all elevated (eg INR > 1.5) then I’d transfuse. If there is a reason for the infant having bleeding eg liver failure- and baby is bleeding then we’ll give it. If a baby has hypotension and is not bleeding then may give FFP to help with volume if PT/PTT out of whack. And I have cryo if fibrinogen
@@TalaTalksNICU calculating fluid rates, changes in fluid rates i.e. if I w feed increases how tpn comes down; commonly forgotten nursing actions/ assessments in nicu, handling of super small premies, what to say and not to say to parents, things docs expect from nicu nurses stuff like that!
Hello! Always great questions! And I don’t have answers! Checking PT and PTT takes so much blood- that honestly by the time I’m checking them if they’re slightly elevated: I’m probably giving FFP or cryo (if fibrinogen
Honestly- not really! Which is why- we won't just treat numbers. If the PT and PTT is elevated and the baby is bleeding out- or hypotensive, then maybe we'd give. Otherwise we would ignore it. (Back to one of first principles of medicine : only get a lab test if you're going to do something with it).
Great question! PT is often unaffected with heparin therapy, and PTT is not a sensitive test. So infant may be anti-coagulated with a normal PT and PTT. Still a complete pain to follow the anti-Xa levels though :(
Cryo takes more processing than FFP, and is not as factor rich many of the other factors (i.e. not the ones listed)- so generally we'd start with FFP, unless it really is for VWF, factor 8, fibrinogen and factor 13.