protocol

Massive Transfusion Protocol

Definition

 

> 10 units of packed red blood cells per 24 hours

 

Goal of massive transfusion protocol

 

Limit critical hypoperfusion while surgical hemostasis obtained

Limit complications

 

Issues

 

1.  Volume status and oxygenation

 

Volume via crystalloids required to maintain tissue perfusion

At some stage blood is also required for oxygenation

 

2.  Acidosis

 

Chemotherapy

Sensitivity

 

High grade tumours often sensitive to intensive chemotherapy

- OS

- Ewings

- MFH

 

Low grade often insensitive 

- Chondrosarcoma

- Parosteal OS 

 

Role

 

1.  Eradication of overt & micrometastasis

- OS 80% have micrometastasis

 

2.  Reduce tumour locally 

- makes limb salvage easier

 

Bone scans

Definition

 

Technetium 99m labelled MDP (Mono - diphosphonate)

 

Advantages

 

1.  Pure gamma emitter

 

2.  Half life only 6 hours

- limits radiation exposure

 

3.  Localises in bone

- chemical interaction on the surface of the hydroxyapatite crystal of bone

- phosphorous component interacts with the endogenous calcium

- produces insoluble technetium calcium phosphate complexes.