Clinical Trial of West-China Perioperative Transfusion Score (WCPTS）for Massive Hemorrhagic Surgery
Clinical Trial of West-China Perioperative Transfusion Score (WCPTS）for Massive Hemorrhagic Surgery
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 7~10g/dL is based on the judgment from anesthesiologists or
 surgeons. Index of transfusion trigger for patients with hemoglobin level between 7/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 7/dL
 and 10g/dL could be calculated by their history about heart and blood pressure, and routine
 monitoring parameters including pulse oximetry, temperature, and the use of vasoactive
 medications. 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.
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, 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 by many health institutions or
 organizations in different countries. 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 7~10g/dL is based on the judgment from anesthesiologists or surgeons on the
 patient's condition including intravascular volume status, ongoing bleeding, any risk factors
 for vital organs ischemia or hypoxia, and so on. Index of transfusion trigger for patients
 with hemoglobin level between 7/dL and 10g/dL is necessary and important in clinical
 practice.

 The aim of blood transfusion is to provide sufficient oxygen for the whole body, and to
 maintain the balance of oxygen supply and oxygen consumption. Factors associated with oxygen
 supply are hemoglobin level, cardiac output (CO), and oxygen saturation. Oxygen consumption
 is increased by the increase of metabolism, which could be reflected by increase of heart
 rate, blood pressure, and body temperature. If a patient's oxygen supply is decreased or
 oxygen consumption is increased, he will need a higher hemoglobin level to maintain the
 balance. Based on these findings, the investigators hypothesize that index of transfusion
 trigger for patients with hemoglobin level between 7/dL and 10g/dL could be calculated by
 their CO (reflectd by the use of adrenalin), and routine monitoring parameters including
 pulse oximetry and core temperature.

 West China Perioperative Transfusion Score (WCPTS)

 The initial score is 7.

 If a patient's cardiac output (CO) is normal without contineous infusion of adrenalin, or his
 SpO2 is more than 95%, or his core temperature is less than 38℃, he doesn't have any bonus
 point factor, and his score is 7.

 If a patient's CO is maintained in normal range by contineous adrenalin infusion with
 concentration of less than 0.05μg/kg.min, or his SpO2 is 85~94%, or his core temperature is
 38~40℃, his score should be added 1 point for every item mentioned above.

 If a patient's CO is only maintained by contineous adrenalin infusion with concentration of
 more than 0.05μg/kg.min, or his SpO2 is less than 84%, or his core temperature is above 40℃,
 his score should be added 2 points for every item mentioned above.

 For example, if a patient's CO is normal, his SpO2 is more than 95%, and his core temperature
 is 39℃,his WCPTS should be calcultaed as 7 plus 1 (core temperature is 39℃), and his final
 score is 8.

 Here's another example, if a patient's CO is normal, his core temperature is less than 38℃,
 but he has COPD and his SpO2 is less than 84%, his score could be calculated as 7 plus 2(SpO2
 is less than 84%), and his final score is 9.

 Value of SaO2 is evaluated 5min after endotracheal intubation with inhalation of compressive
 air.

 The initial score is 7，and the patient's score is calculated by 7 plus the sum of every item.

 Score 7：To maintain the patient's Hb level not less than 7g/dL

 Score 8：To maintain the patient's Hb level not less than 8g/dL

 Score 9：To maintain the patient's Hb level not less than 9g/dL

 Score 10 or >10：To maintain the patient's Hb level not less than 10g/dL
Inclusion Criteria:

 -  patients who sign the consent, with Glasgow Coma Scale (GCS) score of 15, undergoing
 surgery which blood loss could be more than 800ml or 20% of the patient's whole blood
 volume.

 Exclusion Criteria:

 -  Pregnancy

 -  Psychopathy

 -  Refuse to sign consent