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Patient condition may be rapidly changing during MOH.
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Initial haemoglobin concentration may be normal due to haemo-concentration and not reflect the amount of actual blood lost. Clinical judgement is therefore paramount in guiding treatment with blood products.
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Serial monitoring of POC parameters i.e. Hb/ TEG/ ROTEM (every 30 minutes or every 500mls blood loss) and clinical observations are essential to aid effective management of MOH.
The MOH pack should be requested from transfusion when there is ongoing bleeding which is not coming under control despite clotting product transfusion based on POC testing. If required this should be clearly stated to blood bank staff and all correspondence with blood bank should state it relates to the identified MOH case. In addition to the staff mentioned above, a designated porter should be immediately available for collection of blood products.
