ABLA and Tranexamic Acid/Cyklokapron

swarren

We have a spine surgeon who gives Tranexamic Acid in the OR.  He will not answer any queries that reference ABLA because he gave this drug. Even those who EBL is over 800cc.  No transfusions have been given that we are aware of.  The question is:  Is Cyklokapron a new standard of practice and we should not query for ABLA even though the patient meets criteria. Thank You  Sheila

lprescott1

This is an interesting question. Tranexamic acid as you know is given to treat- or more accurately prevent excessive blood loss related to a bleeding event such as surgery, trauma etc. I do not see that administration of this medication in the OR would eliminate the diagnosis of acute blood loss anemia. ABLA describes bleeding which results in a decrease number of RBCs, meaning the production of new red blood cells in the body cannot keep up with the loss of RBCs through bleeding. The indicators used to apply ABLA to a surgical patient would be that same whether this medication was given or not. Look for preoperative H&H - compared to post operative H&H, the significance of the EBL as related to the specific procedure, read the anesthesia report to identify fluid volumes, blood loss, any treatments to include expanders, blood transfusions. Review post operative orders for monitoring of H&H, and any pertinent treatments. I would speak to the surgeon about the application of this diagnosis as compared to the hemorrhage or hematoma to assure s/he understands the difference in the meaning of the codes, discuss what the expected blood loss is for the surgery performed and perhaps identify parameters or clinical indicators to agree would allow for query of this diagnosis amongst your surgical staff.