A tale of two patients

Louise Phillips

Presentation at TORC 2011 Annual SeminarPerioperative Patient Blood Management

Patient 1:43 y.o. Female

Diagnosed with Colorectal Cancer, Stage IIIB

Otherwise healthy

At Diagnosis: Hb 114

TRF 6TRF Sat 8Ferritin 5

8 Days LaterAt Surgery: Hb 108

18-Feb-10

20-Feb-10

22-Feb-10

24-Feb-10

26-Feb-10

28-Feb-10

02-Mar-

10

04-Mar-

100

20

40

60

80

100

120

Haemoglobin

SURGERY

TRANSFUSION2 UNITS RBC

Patient 2:43 y.o. Female

Diagnosed with Colorectal Cancer, Stage IIIB

Otherwise healthy

One significant difference.......

At Diagnosis: Hb 114

TRF 6TRF Sat 8Ferritin 5

Requested (and received)Iron Infusion

8 Days LaterAt Surgery: Hb 129

18-Feb-10

20-Feb-10

22-Feb-10

24-Feb-10

26-Feb-10

28-Feb-10

02-Mar-1

0

04-Mar-1

00

20

40

60

80

100

120

140

Haemog

lobin

SURGERY

FE INFUSION

18-Feb-10

20-Feb-10

22-Feb-10

24-Feb-10

26-Feb-10

28-Feb-10

02-Mar-1

0

04-Mar-1

00

20

40

60

80

100

120

140

Patient 2Patient 1

Haemog

lobin

SURGERY

FE INFUSIONFOR PATIENT 2

TRANSFUSIONPATIENT 1

18-Feb-10

20-Feb-10

22-Feb-10

24-Feb-10

26-Feb-10

28-Feb-10

02-Mar-1

0

04-Mar-1

00

20

40

60

80

100

120

140

Patient 2Patient 1

Haemog

lobin

SURGERY

FE INFUSIONFOR PATIENT 2

TRANSFUSIONPATIENT 1

Three Phases of Patient Blood Management

Patient 1 Patient 2

As a patient• I want (expect) the best care possible• I need to believe I am going to get it• I am prepared to be involved in the decision makingbut...• I (like you) am unusual in my level of knowledge

Interaction between Doctor and Patient

Doctor

Patient

Meaningful Exchange of InformationDiscussion of the optionsShared Decision Making

Thanks to....

• My Medical Team– Dr David Slonim, Mr Martin Chin,

Dr Malcolm Cunningham, Dr Ian Haines

• Help with the presentation– Prof James Isbister– Dr Zoe McQuilten