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["Introduction"]
["The purpose of the Red Blood Cell Clinical Audit tool is to allow for the standardised collection of information on (or about) current practice, and subsequent comparison to best practice guidelines. This can be undertaken as part of a continuous improvement cycle where a risk is identified through the audit, improvements are implemented, and the audit is re-performed. Where no risk is identified, that is, current practice is demonstrated as compliant with guidelines, ongoing monitoring of practice should be continued as part of a quality cycle. Using the audit tool in this way will support organisations in complying with requirements of NSQHS standards which require the establishment of a regular audit program in line with accepted standards of clinical governance in Australian hospitals."]
[]
["The algorithms for appropriateness have been created to align with the National Blood Authority’s Patient Blood Management Guideline: Modules 1-4 and are fully referenced to allow review if required."]
[]
["Patient selection "]
["Patient groups for audit should be determined by the relevant governance committee.  Examples of specific groups include those transfused in a specific clinical unit, or specialty, or those transfused in a specific time period."]
[]
["Modules 5 and 6 have not been covered in this tool (Module 5: obstetrics and maternity, and Module 6: neonatal and paediatrics), therefore these patient groups should  be included with caution."]
[]
["Data collection"]
["Retrospective or concurrent "]
[]
[]
[]
["The tool is primarily aimed at determining the alignment of transfusions against the guidelines; however, base questions have also been included to identify potential issues with single unit policy, reporting for haemovigilance and pre-operative anaemia assessment for patient blood management in elective surgery. If poor performance is flagged in any of these areas, a more targetted audit may be warranted."]
[]
[]
["RESOURCES:"]
["Patient Blood Management Guidelines:"]
["Module 1 Critical Bleeding/Massive Transfusion (https://www.blood.gov.au/pbm-module-1)"]
["Module 2 Perioperative (https://www.blood.gov.au/pbm-module-2)"]
["Module 3 Medical (https://www.blood.gov.au/pbm-module-3)"]
["Module 4 Critical Care (https://www.blood.gov.au/pbm-module-4)"]
[]
["Haemoglobin threshold table (http://resources.transfusion.com.au/cdm/ref/collection/p16691coll1/id/821)"]
["Platelet threshhold table (http://resources.transfusion.com.au/cdm/singleitem/collection/p16691coll1/id/895/rec/1)"]

{"sheet":"Instructions","index":1,"n_rows":103,"n_cols":4,"rows_kept":103,"cut":false,"hidden":false,"merged":[[65,3,72,3],[20,1,22,1],[27,1,27,2]]}
["Item","Definition","Action","Explanation"]
["Page 1 Hospital information",null,"insert information into white text areas"]
["Hospital Name:",null,"Enter your hospital"]
["Year of Data:",null,"Enter a year ","A new Excel file should be created for each calendar year."]
[null,null,null,"A year must be entered so that month summaries can be created, and data validation checks."]
[]
["Clinical Areas:",null,"List up to 25 clinical areas and at least one, enter one area per line This list may be added to (up to a maximum of 25), but it is advised to NOT edit once data entry has commenced.","Creates drop down list of clinical areas on data entry page to allow for customisation for your own hospital needs. Data will be presented as whole hospital or can be presented in clinical areas. EDITING a clinical area name will impact on summary tables and charts.  Adding a NEW clinical area is ok."]
[]
["Specialty Areas:",null,"List up to 25 specialty areas and at least one, enter one area per line This list may be added to (up to a maximum of 25), but it is advised to NOT edit once data entry has commenced.","Creates drop down list of specialty areas on data entry page to allow for customisation for your own hospital needs. Data will be presented as whole hospital or can be presented in specialty areas. EDITING a specialty area name will impact on summary tables and charts.  Adding a NEW specialty area is ok."]
[]
["Data Validation Checks"]
["Dates",null,"no action required","A data validation check occurs to ensure all dates have been correctly entered so summary charts can be created."]
["Page 2 Data Entry Appropriateness"]
["UR NUMBER",null,"enter patient identifier (optional)","This field is optional. Provides reference for your records to investigate further if needed."]
["DATE of TRANSFUSION",null,"enter date as dd/mm/yyyy","A valid date MUST be entered."]
["SPECIALTY AREA ",null,"select one option from drop down box that has been generated from page Hospital Information tab","The drop down box is created from the \"Hospital Information\" tab.  "]
["CLINICAL AREA",null,"select one option from drop down box that has been generated from page Hospital Information tab","The drop down box is created from the \"Hospital Information\" tab.  "]
["Inpatient/Outpatient","Inpatient is defined as patient admitted to a clinical area at least as an overnight admission.","identify if patient received transfusion as an inpatient or outpatient","This assists in determining if RBC transfusion would fit under Single Unit Policy"]
["Type of BLEEDING present, if any","See separate tab DEFINITIONS OF BLEEDING for more information.","select one option from drop down box, which best represents bleeding. ","Used to determine appropriateness of Single Unit Policy for patient; and to determine appropriate use of transfusion in critical bleeding events. This also includes activation of massive transfusion protocol."]
["TRANSFUSION TYPE"]
["RBC transfused","Data for one patient episode with multiple products can be entered as one entry. A transfusion episode is typically defined as the interval in patient care from the time of the prescription and ordering of a defined number of units of whole blood or blood components for a patient and the time of completion of administration of these blood products to that patient.","Select RBC from drop down box if RBC transfused. You have the option of adding if the product was cross matched or if emergency O provided.","Highlights questions needed to be answered to determine appropriateness of RBC transfusion and and if single unit policy should be followed."]
["FFP transfused",null,"Select FFP from drop down box if FFP transfused.","Highlights questions needed to be answered to determine appropriateness of FFP transfusion."]
["Platelets transfused",null,"Select PLATELETS from drop down box if platelets transfused.","Highlights questions needed to be answered to determine appropriateness of platelet transfusion."]
["DOCUMENTATION"]
["CONSENT DOCUMENTED","Consent for transfusion must be obtained and documented. Consent may be a specific form or generic depending on your health service. Documentation may be stored in the patient medical record or electronically.","select one option from predetermined list in drop down box (Y/N)","If left BLANK, will be intrepreted as a NO in the summaries and charts"]
["INDICATION PROVIDED \n(Rationale documented) (Y/N)","Is there a clear statement in the medical notes giving the reason for the transfusion?","select one option from predetermined list in drop down box (Y/N)","Although this audit is not asking what indication was documented, requiring the prescriber to document the indication encourages them to consider if the transfusion is appropriate. \nIf left BLANK, will be intrepreted as a NO in the summaries and charts"]
["ADVERSE EVENT documented\n(VHIMS reference may be added)","Adverse event may be a clinical reaction (e.g., ATR, TACO, TRALI) or procedural error, e.g., IBCT.","select one option from predetermined list in drop down box (Y/N) or the VHIMS reference number may be entered as a cross reference.","Health professionals must report adverse events that occur as a result of administration of blood and blood products, as required by NSQHS Standard 7.  Adverse events must be included in incident management and investigation systems."]
["INVASIVE PROCEDURE / SURGERY","Central or arterial line insertion or removal, broncho-alveolar lavage, lumbar puncture, liver biopsy, upper GI endoscopy, lapartomy/abdominal surgery\n(procedure is to be described in the 'Notes' section if not on this list)."]
["Emergency/Elective","Elective surgery or procedure that is scheduled in advance (and can be delayed for at least 24 hours) because it does not involve a medical emergency.","select one option from predetermined list in drop down box (emergency, elective)"]
["Invasive procedure/surgery - \ntransfusion PRE/INTRA/POST","To determine the timing of the transfusion in relationship to a procedure/surgery. Preoperative transfusion refers to occurring in the period (7 days) before a surgical operation; intraoperative refers to occurring during the course of a surgical operation; or postoperative refers to occurring in the period (7 days) after a surgical operation.","select one option from predetermined list in drop down box"]
["High-risk surgery\n(intracranial, intraocular and neuraxial procedures)","Severe bleeding with the need for allogeneic blood transfusion is relatively uncommon in neurosurgery. However, haematoma growth has a major impact on neurological outcomes and mortality in patients with intracerebral haemorrhage.","select one option from predetermined list in drop down box (Y/N)","Specialist haematology advice should be sought for at-risk patients undergoing intracranial, intraocular and neuraxial procedures."]
["Cardiac surgery","Cardiac surgery is surgery on the heart or great vessels performed by cardiac surgeons. ","select one option from predetermined list in drop down box (Y/N)","Prophylactic use of FFP and platelets is generally not supported/recommended in cardiac surgery. Other PBM guidelines will differentiate between noncardiac and cardiac surgery."]
["Patient identified as anaemic preoperatively:","Hb <130 g/L (male) or Hb <120 g/L (female)",null,"The \"preoperative haemoglobin assessment and optimisation template\" guides practice for patients undergoing procedures in which substantial blood loss is anticipated such as cardiac surgery, major orthopaedic, vascular and general surgery. "]
["Evaluated possible causes of anaemia \neg  iron studies/CRP ?","Evaluate cause of anaemia as possibly due to iron deficiency or as a result of chronic disease or inflammation. This would require ferritin and/or CRP testing, as well as possibly renal function tests, B12 and folate levels.","select one option from predetermined list in drop down box (Y/N)","Will assist with review of transfusion as appropriate."]
["Management of anaemia commenced \n(eg iron therapy, diet) prior to surgery","The preoperative haemoglobin assessment and optimisation template recommends that anaemia is managed before an elective surgery is commenced. Appropriate management may include dietray iron, oral iron, or IV iron.","select one option from predetermined list in drop down box (Y/N)","Will assist with review of transfusion as appropriate. \nIf management is by transfusion only, the response should be \"N\"."]
["Intraoperative blood conservation strategies used","Strategies may include: prevention of hypothermia, appropriate patient positioning, deliberate induced hypotension in specific surgeries, acute normovolaemic haemodilution, cell salvage, haemostasis analysis, use of medications such as tranexamic acid, meticulous operative technique topical haemostatic agents ","select one option from predetermined list in drop down box (Y/N)"," A number of strategies exist that may eliminate the need for transfusion, which is important considering, transfusion may  be associated with increased risks of morbidity and mortality.\nWill assist with review of transfusion as appropriate."]
["PATIENT DIAGNOSIS"]
["Marrow failure/Thalassaemia","The bone marrow failure includes  disorders that can be either inherited or acquired - it is most commonly associated with Fanconi anemia (FA), dyskeratosis congenita, and aplastic anemia. Thalassemia is an inherited blood disorder characterised by less oxygen-carrying protein (haemoglobin) and fewer red blood cells in the body than normal.","Select MARROW FAILURE or THALASSAEMIA from drop down box if applicable.","Used as a trigger (in combination of other variables) for appropriateness of transfusion; and whether Single Unit Policy should be followed."]
["Thrombotic thrombocytopenic purpura (TTP) \nor Heparin-induced thrombocytopenia (HIT)","Thrombotic thrombocytopenic purpura (TTP) is a blood disorder characterized by clotting in small blood vessels of the body (thromboses), resulting in a low platelet count. Heparin-induced thrombocytopenia (HIT)  is a complication of heparin therapy, resulting in the development of thrombocytopenia (a low platelet count).","select one option from predetermined list in drop down box (Y/N)","Used to determine if platelet transfusion indicated, it is contraindicated with TTP and HIT."]
["Disseminated intravascular coagulation (DIC) ","DIC is a condition in which small blood clots develop throughout the bloodstream, blocking small blood vessels. These abnormal clots use up the blood's clotting factors, which can lead to massive bleeding in other places. ",null,"Used as a trigger (in combination of other variables) for appropriateness of transfusion, in particular for FFP."]
["Platelet function disorders","Platelet functional disorders can result in normal platelet levels but platelets are not effective; they may be hereditary (e.g., Bernard-Soulier Syndrome, Glanzmann Thrombasthenia,  Scott Syndrome) or acquired (e.g., due to medication, such as aspirin, NSAIDs, ticlopidine, blood thinners).","select either \"hereditary\" or \"acquired\""]
["Bleeding disorder or factor deficiency","Bleeding disorder or factor deficiency (coagulopathy) is a condition in which the blood's ability to coagulate is impaired, leading to prolonged or excessive bleeding.","select one option from predetermined list in drop down box (Y/N)"]
["Myelodysplasia (MDS)","MDS is a group of diseases that affects normal blood cell production in the bone marrow; producing abnormal, immature blood cells called blast cells. These cells fail to mature properly and are unable to work properly.  "]
["Critically ill ","Patients (usually in intensive care) with acute multi organ failure (>1 organ) with marrow suppression or disseminated intravascular coagulation (DIC) OR patients who are physiologically unstable and at risk of significant morbidity and/or mortality.","select one option from predetermined list in drop down box (Y/N)"]
["Acute coronary syndrome","Acute coronary syndrome is a range of conditions associated with sudden, reduced blood flow to the heart; with clinical symptoms compatible with acute myocardial ischemia, including unstable angina , NSTEMI, STEMI.","Select ACS from drop down box if documented that patient had clinical symptoms compatible with acute myocardial ischemia, including unstable angina , NSTEMI, STEMI.","Used as a trigger (in combination of other variables) for appropriateness of transfusion."]
["RED CELL APPROPRIATENESS/SINGLE UNIT POLICY"]
["Number of RBC units prescribed",null,"Enter number of units PRESCRIBED","Used to determine appropriateness of Single Unit Policy for patient."]
["Number of RBC units transfused",null,"Enter number of units TRANSFUSED","Used to determine appropriateness of Single Unit Policy for patient."]
["Hb level (g/L) pre-transfusion",null,"enter pathology result","Used as a trigger (in combination of other variables) for appropriateness of transfusion."]
["Hb level (g/L) after transfusion of ONE unit",null,"enter pathology result","Used to determine appropriateness of Single Unit Policy for patient."]
["Hb level (g/L) after TOTAL transfusion of units prescribed",null,"enter pathology result"]
["Clinical assessment performed \nafter the FIRST unit of transfusion","Each red blood cell transfusion should be an independent clinical decision based on the risk, benefits and alternatives. Clinical assessment should be based on the need to relieve clinical signs and symptoms of anaemia. Symptoms may include dyspnoea, tachycardia, chest pain, hypotension, increased heart rate and decreased oxygen saturation. This may or may not inlude Hb measurement.","Enter Y from drop down box, if documented that patient was reassessed after one/each unit of RBC","Used to determine appropriateness of Single Unit Policy for patient."]
["Signs/symptoms of impaired oxygen transport","Symptoms may include breathlessness, an increased rate of breathing, use of the chest and abdominal muscles to breathe, and lip pursing.","Select SYMPTOMATIC from drop down box if documented that patient experienced breathlessness.","Used as a trigger (in combination of other variables) for appropriateness of transfusion."]
["PLATELET APPROPRIATENESS"]
["Platelet count (x109/L) pre-transfusion",null,"enter pathology result","Used as a trigger (in combination of other variables) for appropriateness of transfusion."]
["Chemotherapy and/or haematopoietic stem cell transplantation",null,"select one option from predetermined list in drop down box (Y/N)","Used as a trigger (in combination of other variables) for appropriateness of transfusion."]
["Fever/sepsis present","(as a risk factor in bone marrow failure patients) temperature equivalent to or greater than 38° C.","select one option from predetermined list in drop down box (Y/N)","Used as a trigger (in combination of other variables) for appropriateness of transfusion."]
["FRESH FROZEN PLASMA APPROPRIATENESS"]
["INR","INR (international normalized ratio) evaluates the extrinsic pathway of coagulation. The INR is used to monitor patients on warfarin or related oral anticoagulant therapy. The normal range for a healthy person not using warfarin is 0.8–1.2, and for people on warfarin therapy an INR of 2.0–3.0 is usually targeted.  If the INR is outside the target range, a high INR indicates a higher risk of bleeding, while a low INR suggests a higher risk of developing a clot.","enter pathology result"]
["Warfarin","Warfarin is a type of anticoagulant medication. Warfarin is given to either prevent blood clots developing or to stop clots that have already developed from getting larger.","Enter WARFARIN from drop down box, if documented that patient was taking warfarin.","FFP may be appropriate when warfarin reversal is required, and PCC is contraindicated or unavailable."]
["Therapetic apheresis","Therapeutic apheresis is indicated in immunological, haematological, metabolic  and renal conditions and in specific transplantation scenarios.  Specialist advice should be sought on the feasibility of FFP in therapeutic apheresis and should align with local protocols and internationally accepted guidelines. See \"Therapeutic apheresis\" tab.  ","Enter Y from drop down box, if documented that patient was receiving therapeutic apheresis for an evidence-based indication."]
["Calculated Points (cannot be edited - information is pulled from above data entry)"]
["Month",null,"no action required","A month summary is created from the transfusion date."]
["Red cell Appropriateness"]
["Single Unit Policy applies (patient appropriate) ",null,"no action required"]
["R1: Critical Bleeding (Module 1)",null,"no action required","Calculated points are based on the data entered for each individual transfusion. An algorithm is run against the recommendations for appropriate transfusion for each case. See module reference for detail of practice points."]
["R2: Severe anaemia (M3 PP3, M4 PP3)",null,"no action required"]
["R3: Acute coronary syndrome - medical and critical care (M3 PP5, M4 PP4)",null,"no action required"]
["R4: Preoperative (elective with attempted anaemia management, Hb <100)",null,"no action required"]
["R5: Postoperative Acute coronary syndrome (M2 PP3)",null,"no action required"]
["R6: Postoperative (absence of ACS) (M2 PP2)",null,"no action required"]
["R7: Symptomatic - medical and critical care (M3 PP3, M4 PP3)",null,"no action required"]
["R8: Thalassaemia - monthly transfusions (M3 PP23)",null,"no action required"]
["RBC Appropriateness Summary (module/algorithm)",null,"no action required","Summary from above Reason Codes.  See REASON CODES tab for more information."]
["Single Unit Policy Met",null,"no action required","Calculated points are based on the data entered for each individual transfusion, when single unit policy applicable."]
["Reviewed Appropriateness (can be overwritten)",null,"can be overwritten","It has been attempted to run algorithms based against the PBM modules, but there may be times when they do not address all valid events."]
["Reviewed Single Unit Policy met (can be overwritten)",null,"can be overwritten","It has been attempted to run algorithms based against the Single Unit Policy, but there may be times when they do not address all valid events."]
["Platelet Appropriateness"]
["P1: Critical Bleeding (Module 1 PP10)",null,"no action required","Calculated points are based on the data entered for each individual transfusion. An algorithm is run against the recommendations for appropriate transfusion for each case. See module reference for detail of practice points."]
["P2: Perioperative  (M2 PP17 PP18 (review) M4 PP17)",null,"no action required","Due to the nature of high risk patients and a higher threshhold, the algorithm will return with a \"REVIEW\" result, which should be overwritten in the line below."]
["P3: Prophylaxis in bone marrow failure (M3 R8, PP20, PP22)",null,"no action required"]
["P4: Prophylaxis in bone marrow failure with risk factors (M3 R8, PP20, PP22)",null,"no action required"]
["P5: Critically ill in the absence of bleeding (M4 PP11)",null,"no action required"]
["Platelet Appropriateness Summary (module/algorithm)",null,"no action required"]
["Reviewed Appropriateness (can be overwritten)",null,"can be overwritten","It has been attempted to run algorithms based against the PBM modules, but there may be times when they do not address all valid events."]
["Fresh Frozen Plasma Appropriateness"]
["F1: Critical bleeding (PBM 1 - 4.7, 4.8, PP10)",null,"no action required","Calculated points are based on the data entered for each individual transfusion. An algorithm is run against the recommendations for appropriate transfusion for each case. See module reference for detail of practice points."]
["F2: Pre-operative coagulopathy  (minor procedure) (PBM2 - PP17, R21; PBM4 - PP7)",null,"no action required"]
["F3: Pre-operative coagulopathy  (major/emergency procedure) (PBM2 - PP18)",null,"no action required","Due to the nature of the guidelines and the recommendation that haematologist consultation is sought , the algorithm may return with a \"REVIEW\" result for F3 and F6, which should be overwritten in the line below."]
["F4: Warfarin Reversal (PBM3 - PP17)",null,"no action required"]
["F5: Therapeutic apheresis",null,"no action required"]
["F6: Correction of coagulopathy in a bleeding (medical) patient (PBM3 - PP16)",null,"no action required"]
["FFP Appropriateness Summary (module/algorithm)",null,"no action required"]
["Reviewed Appropriateness (can be overwritten)",null,"can be overwritten","It has been attempted to run algorithms based against the PBM modules, but there may be times when they do not address all valid events."]
[]
["‘This work is based on/includes The National Blood Authority’s Patient Blood Management Guideline: Module 1 – Critical bleeding/Massive transfusion, which is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Australia licence’."]
["‘This work is based on/includes The National Blood Authority’s Patient Blood Management Guideline: Module 2 – Perioperative, which is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Australia licence’."]
["‘This work is based on/includes The National Blood Authority’s Patient Blood Management Guideline: Module 3 – Medical, which is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Australia licence’."]
["‘This work is based on/includes The National Blood Authority’s Patient Blood Management Guideline: Module 4 – Critical Care, which is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Australia licence’."]
[]
["The template and algorithms for RBC appropriateness were developed in consultation with Dr Ashvind Prabahran Haematology registrar, Australian Red Cross Blood Service, July 2016"]
["The template and algorithms for platelet appropriateness were developed in consultation with Dr Indu Raman Haematology registrar, Australian Red Cross Blood Service, November 2016"]
["The template and algorithms for FFP appropriateness were developed in consultation with Dr Julian Grabek, Haematology registrar, Australian Red Cross Blood Service, November 2017"]

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[]
[]
[null,"Hospital Name:"]
[]
[null,"Year of Data:",2017,null,null,null,"Enter a year (e.g., 2015)"]
[]
[null,"Specialty area",null,null,"List up to 25 specialty areas, enter one area per line","CLINICAL AREA",null,"List up to 25 clinical areas, enter one area per line"]
[]
[]
[]
[null,null,null,null,"This list may be added to (up to a maximum of 25), but it is advised to NOT edit once data entry has commenced."]
[]
[null,null,null,null,null,null,null,"This list may be added to (up to a maximum of 25), but it is advised to NOT edit once data entry has commenced."]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"Data Validation Checks"]
[null,"Dates",{"$f":"IF(COUNTIF('Data Entry'!2:2,\">=\"&DATE(C5,1,1))-COUNTIF('Data Entry'!2:2,\">=\"&DATE(C5,12,31))=COUNTIF('Data Entry'!2:2,\">=\"&DATE(1900,1,1)),\"No apparent problem with dates\",\"Check DATES, there may be an error with \"&COUNTIF('Data Entry'!2:2,\">=\"&DATE(C5,1,1))-COUNTIF('Data Entry'!2:2,\">=\"&DATE(C5,12,31))-COUNTIF('Data Entry'!2:2,\">=\"&DATE(1900,1,1)))","v":"No apparent problem with dates"}]

{"sheet":"Data Entry","index":3,"n_rows":122,"n_cols":255,"rows_kept":122,"cut":false,"hidden":false,"merged":[]}
["UR NUMBER"]
["DATE of TRANSFUSION"]
["SPECIALTY AREA "]
["CLINICAL AREA "]
["Inpatient/Outpatient"]
["Type of BLEEDING present, if any"]
["TRANSFUSION TYPE"]
["RBC transfused"]
["FFP transfused"]
["Platelets transfused"]
["DOCUMENTATION"]
["CONSENT DOCUMENTED"]
["INDICATION PROVIDED (Rationale documented) (Y/N)"]
["ADVERSE EVENT documented (VHIMS reference may be added)"]
["INVASIVE PROCEDURE / SURGERY"]
["Emergency/Elective"]
["Invasive procedure/surgery - transfusion PRE/INTRA/POST"]
["High-risk surgery (intracranial, intraocular and neuraxial procedures)"]
["Cardiac surgery"]
["If patient identified as anaemic preoperatively:"]
["   Evaluated possible causes of anaemia (eg  iron studies/CRP)?"]
["   Management of anaemia commenced (eg iron therapy, diet) prior to surgery/procedure"]
["Intraoperative blood conservation strageties used"]
["PATIENT DIAGNOSIS"]
["Marrow failure/Thalassaemia"]
["Thrombotic thrombocytopenic purpura (TTP) or Heparin-induced thrombocytopenia (HIT)"]
["Disseminated intravascular coagulation (DIC)"]
["Platelet function disorders"]
["Bleeding disorder or factor deficiency"]
["Myelodysplasia"]
["Critically ill (Patients with acute multi-organ failure with marrow suppression or DIC)"]
["Acute Coronary Syndrome"]
["RED CELL APPROPRIATENESS/SINGLE UNIT POLICY"]
["Number of RBC units prescribed"]
["Number of RBC units transfused"]
["Hb level (g/L) pre-transfusion"]
["Hb level (g/L) after transfusion of ONE unit"]
["Hb level (g/L) after TOTAL transfusion of units prescribed"]
["Clinical assessment performed after the FIRST unit of transfusion"]
["Signs/symptoms of impaired oxygen transport"]
["PLATELET APPROPRIATENESS"]
["Platelet count (x109/L) pre-transfusion"]
["Chemotherapy and/or haematopoietic stem cell transplantation"]
["Fever/sepsis present"]
["FRESH FROZEN PLASMA APPROPRIATENESS"]
["INR"]
["Warfarin"]
["Therapeutic apheresis (see tab for evidence-based indications)"]
["Calculated Points (cannot be edited - information is pulled from above data entry)"]
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["Red Cell Appropriateness"]
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[]
["Fresh Frozen Plasma Appropriateness"]
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[" "]
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[null,{"$f":"'Hosp Info'!C10","v":0},null,null,null,{"$f":"'Hosp Info'!G10","v":0}]
["Year",{"$f":"'Hosp Info'!C11","v":0},"DIC",null,null,{"$f":"'Hosp Info'!G11","v":0},null,null,"RBC"]
[{"$f":"'Hosp Info'!C5","v":2017},{"$f":"'Hosp Info'!C12","v":0},"DIC",null,null,{"$f":"'Hosp Info'!G12","v":0},null,null,"RBC"]
[null,{"$f":"'Hosp Info'!C13","v":0},null,null,null,{"$f":"'Hosp Info'!G13","v":0},null,null,"RBC-Xmatched"]
[null,{"$f":"'Hosp Info'!C14","v":0},null,null,null,{"$f":"'Hosp Info'!G14","v":0},null,null,"RBC-EmergO"]
["Inpatient/Outpatient",{"$f":"'Hosp Info'!C15","v":0},"Warfarin",null,null,{"$f":"'Hosp Info'!G15","v":0}]
["Inpatient",{"$f":"'Hosp Info'!C16","v":0},"Warfarin",null,null,{"$f":"'Hosp Info'!G16","v":0}]
["Outpatient",{"$f":"'Hosp Info'!C17","v":0},null,null,null,{"$f":"'Hosp Info'!G17","v":0}]
[null,{"$f":"'Hosp Info'!C18","v":0},null,null,null,{"$f":"'Hosp Info'!G18","v":0}]
[null,{"$f":"'Hosp Info'!C19","v":0},null,null,null,{"$f":"'Hosp Info'!G19","v":0}]
["Types of bleeding",{"$f":"'Hosp Info'!C20","v":0},"Transfusion occurred",null,null,{"$f":"'Hosp Info'!G20","v":0}]
["1a Trace",{"$f":"'Hosp Info'!C21","v":0},"Pre",null,null,{"$f":"'Hosp Info'!G21","v":0}]
["1b Mild",{"$f":"'Hosp Info'!C22","v":0},"Intra",null,null,{"$f":"'Hosp Info'!G22","v":0}]
["2a Serious",{"$f":"'Hosp Info'!C23","v":0},"Post",null,null,{"$f":"'Hosp Info'!G23","v":0}]
["2b Serious with morbidity",{"$f":"'Hosp Info'!C24","v":0},null,null,null,{"$f":"'Hosp Info'!G24","v":0}]
["2c Fatal bleeding",{"$f":"'Hosp Info'!C25","v":0},null,null,null,{"$f":"'Hosp Info'!G25","v":0}]
["MTP activated",{"$f":"'Hosp Info'!C26","v":0},null,null,null,{"$f":"'Hosp Info'!G26","v":0}]
[null,{"$f":"'Hosp Info'!C27","v":0},null,null,null,{"$f":"'Hosp Info'!G27","v":0}]
[null,{"$f":"'Hosp Info'!C28","v":0},null,null,null,{"$f":"'Hosp Info'!G28","v":0}]
["Marrow failure/Thalassemia",{"$f":"'Hosp Info'!C29","v":0},null,null,null,{"$f":"'Hosp Info'!G29","v":0}]
["Marrow failure",{"$f":"'Hosp Info'!C30","v":0},null,null,null,{"$f":"'Hosp Info'!G30","v":0}]
["Thalassaemia",{"$f":"'Hosp Info'!C31","v":0},null,null,null,{"$f":"'Hosp Info'!G31","v":0}]
["Both"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"STAGE 3 ckd ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"gi loss "]
[{"$f":"'Hosp Info'!C5","v":2017}]
[]
[]
["REVIEW - what does it mean?"]
["Some reason codes based on the modules state that specialist haematology advice is required (and consequently cannot be interpreted purely based on algorithm). "]

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[null,"Jan","Feb","Mar","Apr","May","Jun","Jul","Aug","Sep","Oct","Nov","Dec","Total",null,null,"Jan","Feb","Mar","Apr","May","Jun","Jul","Aug","Sep","Oct","Nov","Dec","Total"]
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[]
[]
["Appropriateness by Specialty (counts)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Appropriateness by Specialty (counts)"]
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["Appropriateness by Clinical Area (counts)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Appropriateness by Clinical Area (counts)"]
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["Total by Clinical Area ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Total by Clinical Area "]
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{"sheet":"Appropriateness Charts","index":5,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":true,"merged":[]}

{"sheet":"Plt Summary","index":6,"n_rows":164,"n_cols":29,"rows_kept":164,"cut":false,"hidden":false,"merged":[]}
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[]
[]
["Appropriateness by Specialty (counts)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Appropriateness by Specialty (counts)"]
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["Appropriateness by Clinical Area (counts)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Appropriateness by Clinical Area (counts)"]
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["Total by Clinical Area ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Total by Clinical Area "]
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{"sheet":"FFP Summary","index":7,"n_rows":164,"n_cols":29,"rows_kept":164,"cut":false,"hidden":false,"merged":[]}
["REVIEWED APPROPRIATENESS",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"MODULE (ALGORITHM) APPROPRIATENESS"]
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[]
[]
["Appropriateness by Specialty (counts)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Appropriateness by Specialty (counts)"]
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["Total by Specialty (counts)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Total by Specialty (counts)"]
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["Appropriateness by Clinical Area (counts)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Appropriateness by Clinical Area (counts)"]
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["Total by Clinical Area ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Total by Clinical Area "]
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["Percentage Appropriate by Clinical Area ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Percentage Appropriate by Clinical Area "]
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{"sheet":"SingleUnit","index":8,"n_rows":6,"n_cols":14,"rows_kept":6,"cut":false,"hidden":false,"merged":[]}
["SINGLE UNIT POLICY"]
["RBC","Jan","Feb","Mar","Apr","May","Jun","Jul","Aug","Sep","Oct","Nov","Dec","Total"]
["RBC-ALL",{"$f":"SUMPRODUCT(('Data Entry'!50:50=B2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=C2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=D2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=E2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=F2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=G2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=H2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=I2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=J2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=K2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=L2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=M2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))))","v":0},{"$f":"SUM(B3:M3)","v":0}]
["RBC-Single unit applies",{"$f":"SUMPRODUCT(('Data Entry'!50:50=B2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!52:52=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=C2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!52:52=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=D2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!52:52=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=E2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!52:52=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=F2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!52:52=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=G2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!52:52=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=H2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!52:52=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=I2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!52:52=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=J2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!52:52=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=K2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!52:52=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=L2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!52:52=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=M2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!52:52=\"Y\")))","v":0},{"$f":"SUM(B4:M4)","v":0}]
["Single unit policy met",{"$f":"SUMPRODUCT(('Data Entry'!50:50=B2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!65:65=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=C2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!65:65=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=D2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!65:65=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=E2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!65:65=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=F2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!65:65=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=G2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!65:65=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=H2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!65:65=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=I2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!65:65=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=J2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!65:65=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=K2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!65:65=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=L2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!65:65=\"Y\")))","v":0},{"$f":"SUMPRODUCT(('Data Entry'!$50:$50=M2)*(ISNUMBER(SEARCH($A$2,'Data Entry'!$8:$8,1))*('Data Entry'!65:65=\"Y\")))","v":0},{"$f":"SUM(B5:M5)","v":0}]
["% Single Policy Met\n(where appropriate)",{"$f":"IF(B4>0,B5/B4,\"\")","v":""},{"$f":"IF(C4>0,C5/C4,\"\")","v":""},"","","","","","","","","","",""]

{"sheet":"RBC Chart","index":9,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[]}

{"sheet":"Plt Chart","index":10,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[]}

{"sheet":"FFP Chart","index":11,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[]}

{"sheet":"Definitions of Bleeding","index":12,"n_rows":35,"n_cols":12,"rows_kept":35,"cut":false,"hidden":false,"merged":[]}
["Type of bleeding",null,null,null,null,null,null,null,null,null,"Clinically Significant Bleeding"]
[]
["Grade 1: not clinically significant"]
["Grade 1(a): trace bleeding",null,null,null,null,null,null,null,null,null,null,"N"]
[null,"Minimal bleeding or bleeding detectable by laboratory measures only. "]
[null,"Bleeding does not have any impact on patient or care provided to patient."]
["Grade 1(b): mild bleeding",null,null,null,null,null,null,null,null,null,null,"N"]
[null,"Non–clinically significant bleeding. Bleeding associated with no impact on patient or level of care provided to patient. "]
[null,"(Bleeding does not meeting criteria listed for “Grade 2/Clinically significant bleeding.”)"]
["Grade 2: clinically significant bleeding"]
["Grade 2(a): serious bleeding",null,null,null,null,null,null,null,null,null,null,"Y"]
[null,"Any bleeding resulting in one or more of the following: pain; need for interventions "]
[null,"(including transfusion, surgery, invasive procedures, administration of medication); "]
[null,"or need for invasive investigations or increased monitoring."]
["Grade 2(b): serious bleeding with significant morbidity",null,null,null,null,null,null,null,null,null,null,"Y"]
[null,"Any bleeding meeting one of the following criteria: "]
[null,"all central nervous system bleeding, resulting in hemodynamic instability, "]
[null,"resulting in vision loss, resulting in significant morbidity."]
["Grade 2(c): fatal bleeding",null,null,null,null,null,null,null,null,null,null,"Y"]
[null,"Any bleeding directly contributing to patient's death."]
[]
["Webert, K. E., Arnold, D. M., Lui, Y., Carruthers, J., Arnold, E. and Heddle, N. M. (2012), "]
["A new tool to assess bleeding severity in patients with chemotherapy-induced thrombocytopenia (CME). "]
["Transfusion, 52: 2466–2474. doi: 10.1111/j.1537-2995.2012.03634.x"]
["NBA in Single Unit Transfusion Guide uses Webert definition for clinically significant bleeding"]
[]
[]
["MTP activated",null,null,null,null,null,null,null,null,null,null,"Y"]
["Massive Transfusion protocol (MTP)"]
["Suggested criteria for activation of MTP"]
[null,"• Actual or anticipated 4 units RBC in < 4 hrs, + haemodynamically unstable, +/– anticipated ongoing bleeding"]
[null,"• Severe thoracic, abdominal, pelvic or multiple long bone trauma"]
[null,"• Major obstetric, gastrointestinal or surgical bleeding"]
[]
["The National Blood Authority’s Patient Blood Management Guideline: Module 1 – Critical Bleeding/Massive Transfusion"]

{"sheet":"RBC Reason Codes","index":13,"n_rows":14,"n_cols":3,"rows_kept":14,"cut":false,"hidden":false,"merged":[[7,2,8,2],[7,0,8,0],[13,0,13,2]]}
["Reason code: Red Cell","Module reference","Algorithm"]
["R1: Critical Bleeding (Module 1)","Critical bleeding is defined as “major haemorrhage that is life threatening and likely to result in the need for massive transfusion\"","Patient reported to have serious bleeding with significant morbidity or fatal bleeding (Webert 2012). This will also identify appropriate transfusion intraoperative when an unexpected significant bleed occurs"]
["R2: Severe anaemia (M3 PP3, M4 PP3)","M3PP3/M4PP3 Hb concentration <70 g/L, RBC transfusion may be associated with reduced mortality and is likely to be appropriate. However, transfusion may not be required in well-compensated patients or where other specific therapy is available.","Patient reported to have a Hb pre-transfusion of less than 70"]
["R3: Acute coronary syndrome - medical and critical care (M3 PP5, M4 PP4)","M3PP5/M4PP3 In patients with ACS and a Hb concentration <80 g/L, RBC transfusion may be associated with reduced mortality and is likely to be appropriate. (See M3 PP1 and PP2).","Patient reported Hb less than 80, ACS and no invasive procedure/surgery reported"]
["R4: Preoperative (elective with attempted anaemia management, Hb <100)",null,"Patient reported to have elective surgery with a pre-surgery of Hb<100, and reported commencement of anaemia management."]
["R5: Postoperative Acute coronary syndrome (M2 PP3)","M2PP3 Patients should not receive a transfusion when the haemoglobin level is ≥100 g/L. In postoperative patients with acute myocardial or cerebrovascular ischaemia and a haemoglobin level of 70–100 g/L, transfusion of a single unit of RBC, followed by reassessment of clinical efficacy, is appropriate.","Patient reported Hb  less than 100, and transfusion occurred post  operative with ACS"]
["R6: Postoperative (absence of ACS) (M2 PP2)","M2PP2 RBC transfusion should not be dictated by a haemoglobin ‘trigger’ alone, but should be based on assessment of the patient’s clinical status. In the absence of acute myocardial or cerebrovascular ischaemia, postoperative transfusion may be inappropriate for patients with a haemoglobin level of >80 g/L.","Patient reported Hb equal to or less than  80, transfusion occurred post  operative and ACS not reported"]
["R7: Symptomatic - medical and critical care (M3 PP3, M4 PP3)","M3PP3 Hb concentration of 70–100 g/L, RBC transfusion is not associated with reduced mortality. The decision to transfuse patients (with a single unit followed by reassessment) should be based on the need to relieve clinical signs and symptoms of anaemia, and the patient’s response to previous transfusions. No evidence was found to warrant a different approach for patients who are elderly or who have respiratory or cerebrovascular disease.","Patient reported to have Hb between 70 and 100 (inclusive), no ACS, no invasive procedure/surgery reported WITH symptoms of impaired oxygen "]
[null,"M4PP3 Hb concentration of 70–90 g/L, RBC transfusion is not associated with reduced mortality. The decision to transfuse patients (with a single unit followed by reassessment) should be based on the need to relieve clinical signs and symptoms of anaemia."]
["R8: Thalassaemia – regular transfusions (M3 PP23)","M3PP23 In patients with thalassaemia, the evidence does not support any change to the current practice of maintaining a pretransfusion Hb concentration of 90–100 g/L, with transfusions at about monthly intervals.","Patient reported to have Hb of 100 or less and thalassaemia"]
["R9: Myelodysplasia (M3 PP24)","M3PP24 In patients with myelodysplasia who are regularly and\nchronically transfused, there is no evidence to guide particular\nHb thresholds. Decisions around appropriate triggers and frequency of transfusion need to be individualised, taking into account anaemia-related symptoms, functional or performance status, and the patient’s response to previous transfusions.","All myelodysplasia are highlighted with \"REVIEW\" to determine if appropriate for the individual patient."]
["NOT APPROPRIATE: Hb greater 100 (M2 PP3, M3 PP3, M4 PP3)","Hb concentration >100 g/L, RBC transfusion is likely to be unnecessary and is usually inappropriate. Transfusion has been associated with increased mortality in patients with ACS."]
[]
["The template and algorithms for RBC appropriateness were developed in consultation with Dr Ashvind Prabahran Haematology registrar, Australian Red Cross Blood Service, July 2016"]

{"sheet":"Plt Reason Codes","index":14,"n_rows":11,"n_cols":3,"rows_kept":11,"cut":false,"hidden":false,"merged":[[7,0,7,2]]}
["Reason code: Platelets","Module reference","Algorithm"]
["P1: Critical Bleeding (Module 1 PP10)","Critical bleeding is defined as “major haemorrhage that is life threatening and likely to result in the need for massive transfusion","Patient reported to have \"massive transfusion protocol\" activated."]
["P2: Perioperative  (M2 PP17 PP18 (review) M4 PP12)","M2 PP17: Patients with a platelet count ≥50 × 109/L or an INR ≤2 can undergo invasive procedures without any serious bleeding; however, lower platelet counts and higher INRs may be tolerated.\nM2 PP18: Haematology advice should be sought for at-risk patients undergoing intracranial, intraocular and neuraxial procedures, and for patients with severe thrombocytopenia or coagulopathy.\nM4 PP12: Assessment of bleeding risk is complex and requires careful consideration of patients’ clinical status and laboratory parameters. Specialist haematology advice may also be required. However, patients with a platelet count ≥50 × 109/L can generally undergo invasive procedures within the ICU without any serious bleeding; lower platelet counts may be tolerated in certain clinical situations.","Patient undergoing invasive procedure with a reported platelet count less than 50 × 109/L.  For patients undergoing invasive procedure with a platelet count between 50 and 100 × 109/L, they are highlighted with \"REVIEW\" to determine if they are potentially high risk patients."]
["P3: Prophylaxis in bone marrow failure without risk factors (M3 R8, PP20, PP22)","M3 R8: In patients undergoing chemotherapy and haematopoietic stem cell transplantation, the recommended strategy for prophylactic use of platelets is transfusion at a platelet count of <10 × 109/L in the absence of risk factors, and at <20 × 109/L in the presence of risk factors (e.g. fever, minor bleeding).","Patient reported to be undergoing chemotherapy or haematopoietic stem cell transplantation and have a a platelet count of <10 × 109/L with no risk factors"]
["P4: Prophylaxis in bone marrow failure with risk factors (M3 R8, PP20, PP22)","M3 R8: In patients undergoing chemotherapy and haematopoietic stem cell transplantation, the recommended strategy for prophylactic use of platelets is transfusion at a platelet count of <10 × 109/L in the absence of risk factors, and at <20 × 109/L in the presence of risk factors (e.g. fever, minor bleeding).","Patient reported to be undergoing chemotherapy or haematopoietic stem cell transplantation and have a a platelet count of <20 × 109/L with known risk factors (fever, sepsis or mild bleeding)."]
["P5: Critically ill in the absence of bleeding (M4 PP11)","M4 PP11: In critically ill patients, in the absence of acute bleeding, the administration of platelets may be considered appropriate at a platelet count of <20 × 109/L.","Patient reported to be critically ill and have a platelet  count of <20 × 109/L."]
[]
["The template and algorithms for platelet appropriateness were developed in consultation with Dr Indu Raman, Haematology registrar, Australian Red Cross Blood Service, November 2016"]
[]
[]
[null," "]

{"sheet":"FFP Reason Codes","index":15,"n_rows":14,"n_cols":4,"rows_kept":14,"cut":false,"hidden":false,"merged":[[13,0,13,2]]}
["Reason Code: FFP","Recommendation","Algorithm","BG comments"]
["F1: Critical bleeding (PBM 1 - 4.7, 4.8, PP10)","Critical bleeding defined as major haemorrhage that is life threatening and likely to result in a need for massive transfusion.  Massive transfusion as defined as transfusion of half of one blood volume in 4 hours, or more than one blood volume in 24hrs.  There is insufficient evidence for specific INR/APTT trigger for FFP but a ratio of <2:1 of RBC to FFP is associated with reduced mortality","Patient reported to have \"massive transfusion protocol\" activated."]
["F2: Pre-operative coagulopathy  (minor procedure) \n(PBM2 - PP17; PBM4 - PP7)","No defined threshold of INR/APTT to trigger replacement with FFP.  For minor procedures an INR<2.0 is considered adequate for haemostasis but replacement with FFP may be indicated if the clinical scenario warrants correction, in consultation with a haematologist/transfusion service. Where a specific factor deficiency is present, factor concentrates are recommended.  ","procedure/surgery = PRE and INR >2"]
["F3: Pre-operative coagulopathy  (major/emergency procedure) (PBM2 - PP18)","No defined threshold of INR/APTT to trigger replacement with FFP.  Replacement with FFP should be initiated in conjunction with consultation with a haematologist/transfusion service. Where a specific factor deficiency is present, factor concentrates are recommended if available","procedure/surgery = PRE and high risk surgery, except in the case of cardiac surgery"]
["F4: Warfarin Reversal (PBM3 - PP17)","Correction of a prolonged INR due to warfarin in the bleeding or pre-operative setting at a dose of 15-30ml/kg where Prothrombinex (prothrombin complex concentrate) is unavailable or contraindicated (Tran et al., 2013, An update of consensus guidelines for warfarin reversal, Med J Aust).","Patient reported to be on warfarin AND Procedure/surgery = PRE AND PCC contraindicated as demonstrated by (thrombosis OR DIC OR acute coronary syndrome)"]
["F5: Therapeutic Apheresis","There is no NBM module that covers the use of FFP for therapeutic apheresis.  Therapeutic apheresis is indicated in immunological, haematological, metabolic  and renal conditions and in specific transplantation scenarios.  Specialist advice should be sought on the feasibility of FFP in therapeutic apheresis and should align with local protocols and internationally accepted guidelines. See \"Therapeutic apheresis\" tab.  (Schwartz et. al, 2016, Guidelines on the use of therapeutic apheresis in clinical practice, Journal of Clinical Apheresis)","Therapeutic apheresis is marked as YES; this relies on the use of therapeutic apheresis only in evidence-based indications (see separate TAB)."]
["F6: Correction of coagulopathy in a bleeding patient (non-operative, non-critical) \n(PBM3 - PP16)","No defined INR/APTT threshold for replacement with FFP. Replacement with FFP should be guided by input from a haematoligist/transfusion service.","Medical patient reporting NO procedure/surgery WITH DIC or bleeding present. If these conditions are met, REVIEW will be  highlighted to determine manual appropriateness."]
[]
["NOT APPROPRIATE"]
["F7: Routine surgical bleeding prophylaxis (PBM2 - R21)","No evidence for prophylactic FFP, particularly within cardiac sugery. In critically ill surgical patients, FFP can carry an additional increased risk of infection."]
["F8: Routine correction of coagulopathy in the absence of bleeding \n(PBM3 - PP16, PBM4 - PP5)","Routine use of FFP to correct abnormal coagulation tests is not recommended in the absence of any significant bleeding or operative requirements.  This includes liver disease and pancreatic disease induced coagulopathy"]
["F9: DOAC Reversal","There is no indication for FFP in DOAC (anti-Xa inhibitor, direct thrombin inhibitor) reversal. In the event of bleeding, FFP can be considered where an appropriate reversal agent is not available but haematologist consultation has been sought (Tran et al., 2014, New oral anticoagulants: a practical guide on prescription, laboratory testing and peri-procedural/bleeding management, Internal Medicine Journal)"]
[]
["The template and algorithms for fresh frozen plasma appropriateness were developed in consultation with Dr Julian Grabek, Haematology registrar, Australian Red Cross Blood Service, November 2017"]

{"sheet":"Therapeutic apheresis","index":16,"n_rows":25,"n_cols":4,"rows_kept":25,"cut":false,"hidden":false,"merged":[[19,1,19,3],[24,0,24,5]]}
["Evidence-based indication of the use of the use of FFP in therapeutic apheresis"]
[]
[null,"Haematology","Category I","Thrombotic thrombocytopenic purpura"]
[null,null,null,"Thrombotic microangiopathy, complement mediated  (autoantibody to factor H)"]
[null,null,null,"Thrombotic microangiopathy, drug associated (ticlopidine)"]
[null,null,"Category II","ABO-incompatible haemopoietic stem cell transplantation (high titre isohaemagglutinin)"]
[null,"Renal","Category I","Antineutrophil cytoplasmic antibody (ANCA)-associated rapidly progressive glomerulonephritis (DAH)"]
[null,null,null,"Goodpasture’s syndrome (anti-glomerular basement membrane antibodies) (DAH)"]
[null,null,null,"Focal segmental glomerulosclerosis (recurrent in transplanted kidney)"]
[null,null,null,"Renal transplantation (desensitisation, living donor)"]
[null,null,null,"Renal transplantation (ABOi, living donor)"]
[null,null,null,"Antibody-mediated renal transplant rejection"]
[null,"Metabolic","Category I","Fulminant Wilson’s disease"]
[null,null,null,"Acute liver failure"]
[null,null,null,"Liver transplantation (desensitisation, living donor)"]
[null,"Immunological","Category II","Catastrophic antiphospholipid syndrome"]
[null,null,null,"Severe systemic lupus erythematosus (SLE)"]
[null,"Cardiac","Category II","Cardiac transplantation (desensitisation)"]
[null,"Poisoning/Envenomation","Category II","Mushroom poisoning/Snake bite where significant coagulopathy present"]
[null,"This list incorporates only indications with a proven category I or II recommendation for the use of FFP in plasma exchange.  For other indications for plasma exchange, the use of FFP can be consider in the setting of coagulopathy or bleeding where this may be exacerbated by the absence of adequate plasma replacement. Where the indication of FFP is uncertain specialist advice should be sought and practice should align with local protocols and internationally accepted guidelines \n(Indications adapted from Schwartz et. al, 2016, Guidelines on the use of therapeutic apheresis in clinical practice, Journal of Clinical Apheresis)\n"]
[]
[]
["https://www.ncbi.nlm.nih.gov/pubmed/27322218"]
[]
["Schwartz, J., Padmanabhan, A., Aqui, N., Balogun, R. A., Connelly-Smith, L., Delaney, M., Dunbar, N. M., Witt, V., Wu, Y. and Shaz, B. H. (2016), Guidelines on the Use of Therapeutic Apheresis in Clinical Practice–Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue. J. Clin. Apheresis, 31: 149–338."]