Patients with liver disease receive almost 1 of every 5 blood products transfused in hospitals! Dr. Jeannie Callum thinks that is too much, and she shares how we can improve our practice in these complex patients.
Dr. Jeannie Callum, an outstanding Transfusion Medicine physician who also happens to be a clinician, says that the laboratory picture usually doesn’t tell us the whole story! She explains the complex coagulation disturbance seen in patients with liver disease, and helps us understand that these patients are actually better than their lab tests make them seem (in fact, they may actually be at risk of clotting if we transfuse them!). Jeannie explains the “rebalanced” coagulation system and the reasons why these patients get thrombocytopenic (and why just looking at the platelet count would lead you to be overly pessimistic). She then takes us on a tour of non-transfusion and transfusion choices for patients with liver disease. This interview is guaranteed to open your eyes to things you may not have known!
Jeannie L. Callum, MD, FRCPC, is a Transfusion Medicine Specialist and Hematologist at Sunnybrook Health Sciences Center in Toronto and associate professor of the Department of Laboratory Medicine and Pathobiology at the University of Toronto. She is the Director of Utilization for the Department of Laboratory Medicine and Molecular Diagnostics. She also serves as the sponsor lead for the Ontario Regional Blood Coordinating Network for Central Ontario.
Dr. Callum earned her medical degree and completed a fellowship in internal medicine at the University of Toronto. In addition, she received transfusion medicine fellowship training with Canadian Blood Services. She has written extensively about issues in Transfusion Medicine, publishing more than 100 peer-reviewed articles and authoring numerous book chapters. She also was the lead author on the Provincial (Ontario) transfusion handbook titled “Bloody Easy,” now in its fourth edition (if you don’t have it already, go to transfusionontario.org and get a free download!). In addition, she is on the editorial board for the “Transfusion Medicine Reviews” and “Transfusion” journals.
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DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. See the Wiley Health Learning site for Dr. Callum’s disclosures. Dr. Chaffin has no relevant financial disclosures.
The images below are generously provided by Dr. Callum.
- Kaufman RM, et al. Platelet Transfusion: A Clinical Practice Guideline From the AABB. Ann Intern Med. 2015;162(3):205-13
- Lisman T et al. Intact thrombin generation and decreased fibrinolytic capacity in patients with acute liver injury or acute liver failure. J Thromb Haem 2012;20:1312-1319
- Desborough MJ et al. Patterns of blood component use in cirrhosis: A nationwide study. Liver Int. 2016;36:522-529
- Jia Q et al. Prophylactic plasma transfusion for surgical patients with abnormal preoperative coagulation tests: A single-institution propensity-adjusted cohort study. Lancet Haematology 2016;3:e139-148
- Warner MA et al. Changes in International Normalized Ratios After Plasma Transfusion of Varying Doses in Unique Clinical Environments. Anesth and Analg 2018;127:349-357
- The HALT_IT Trial evaluating use of tranexemic acid in gastrointestinal bleeding
- Choosing Wisely Canada Transfusion Recommendations (especially note #3)