Head and Neck Cancer Transfusion Planning Algorithm (TPRA Model)

Description

Weber developed a model for predicting if a patient undergoing surgery for a head and neck cancer will require transfusion. The author is from the University of Texas M.D. Anderson Cancer Center.

TPRA = transfusion prediction and risk assessment model

Patient selection: age from 18 to 74 years

Parameters:

(1) stage of tumor

(2) type of surgery planned

(3) preoperative hemoglobin

No.	Tumor Stage	Surgery Planned	Preoperative Hemoglobin	Transfusion Rate
1	not T3/T4	no flap	normal hemoglobin	0.02
2	not T3/T4	no flap	below normal Hgb	0.09
3	not T3/T4	flap	normal hemoglobin	0.13
4	not T3/T4	flap	below normal Hgb	0.46
5	T3/T4	no flap	normal hemoglobin	0.04
6	T3/T4	no flap	below normal Hgb	0.18
7	T3/T4	flap	normal hemoglobin	0.25
8	T3/T4	flap	below normal Hgb	0.65

after Figure 2, Weber (1995), page 13

where:

• The lower limit for hemoglobin in the study was 14 g/dL for males and 12 g/dL for females.

• The lower limit for reference range for hemoglobin in g/dL by age (Tietz, page 314) are:

age	Male	Female
18 - 44 years	13.2	11.7
45 - 64 years	13.1	11.7
65 - 74 years	12.6	11.7

Preoperative Planning

No.	Transfusion Needs
1	transfusion unlikely (consider clot and hold)
2	perform a type and screen
3	perform a type and screen
4	expect transfusion; perform type and crossmatch
5	transfusion unlikely (consider clot and hold)
6	perform a type and screen
7	expect transfusion; perform type and crossmatch
8	expect transfusion; perform type and crossmatch

Prepare for Transfusion:

(1) Options: preoperative autologous blood donation and/or crossmatch

(2) If the preoperative hemoglobin is >= 11 g/dL, then autologous donation may be sufficient.

(3) If the preoperative hemoglobin is < 11 g/dL, then the patient may not be a candidate for autologous donation. A type and crossmatch is usually necessary.

Alternative Equation

Parameters:

(1) preoperative hemoglobin

(2) cancer T stage

(3) flap used or not

Parameter	Finding	Points
preoperative hemoglobin	normal or above	0
	below normal	1
cancer stage	T1 or T2	0
	T3 or T4	1
flap	not used	0
	used	1

X =

= (1.71 * (points for hemoglobin)) + (0.775 * (points for stage)) + (2.12 * (points for flap)) – 3.909

probability of transfusion =

= 1 / (1 + EXP((-1) * X))

If the risk of transfusion is low, then no blood bank orders are indicated.

If the risk of transfusion is 5 to 19%, then a type and screen is indicated.

If the risk of transfusion is >= 20% then blood should be available (either type and crossmatch or preoperative autologous blood donation).

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Description

Specialty

Objective

ICD-10

Transfusion Planning Algorithm of Weber in Surgical Patients with Cancer of the Head and Neck (TPRA Model)

Purpose: To predict the need for transfusion in patients having surgery for cancer of the head and neck based on preoperative findings.

Description

Specialty

Objective

ICD-10