Liver Transplant Workup
Scans
CT / MRI
- not routine; only if indicated / ordered by Con
- ensure CT always comes before bone scan
BMD & Bone scan
- need to CPOE
- usually D3; takes a whole day
- book slot with apt counter
- tell SN to call 5357 to do listing
- ensure it's done before CT
Referrals
Physician
Dental
- refer on D1; latest by 8am on D2
- inform dentist that there is no CI for dental intervention and there is no need for abx prophylaxis
Endocrine
refer on D2
ID
refer on D2; ID will ask for vaccinations and more bloods
CVM
via email : Tx reg will do
Anaesthesia
once all Ix are done - either on Thurs /Fri ( to confirm with them )
Renal
if acute renal impairment or existing renal failure
RCCM
If h/o asthma / COPD or if spirometry is abnormal
Allied Health
PT
Dietitian
if BMI low or if DM / HLD
DNE
if DM
MSW
Others
spirometry
- need to CPOE; TC might have pre-booked
- on D2; usually morning
2DE
- need to CPOE; TC might have pre-booked
- on D2; noon
- need to go down to the lab to book slot
MIBI
- usually pre-booked and performed before admission
- ensure you have a recent report
- can call 6704 8172 / 6704 8181 to confirm
CRE / VRE rectal swabs
CPOE
ECG
CXR
Bloods
D1
( SN to do )
Virology
- HbsAb, anti-Hbs,HbeAg, anti-Hbe Ab, anti-Hbc total, Anti HCV IgG, anti-HAV IgG,
- HIV
Hematology
FBC, retic, PT/aPTT/INR, fibrinogen
Immunology
- VDRL, TPPA
- Toxo IgG, anti liver Abs, ANA, anti-SMA
- CMV IgG, EBV IgG, VZV IgG,
- Tb T spot ( call 63214922 to book )
Biochem
RP, LFT, Fe panel, ceruloplasmin, AFP, CEA
Others
- PSA total
- Vit D level
- NH3
- lactate
D2 - fasting
( MO to do )
Blood Bank
GXM
the usual paper form
ABO / Rh testing
CPOE order ( type ABO )
Antibody screening
CPOE order ( type Antibody )
ABG
ensure there is no air bubble ( can result in pO2 > 100 & will be rejected )
Biochem
Lipids, glucose, TFT, Ca/P/Mg
Scopes
- ensure pt has a recent OGD /colono
- if not, arrange for it on a free day inpatient
Urine
24hr urine protein
24hr urine creat
- start on D1
- instruct SN that scans / clinic visits shouldn't interrupt collection
UFEME
urine microalbumin
TC = transplant coordinator
SN = staff nurse
MO = medical officer
= important tips
D1
- admit
- blds by SN ( easier to do when setting iv plug )
- order 2DE, spiro, BMD, bone scan
- KIV refer dental if before 5pm
D2
- fasting blds
- refer dental 8am if not done on D1
- refer PT, dietitian, DNE, MSW
- dental clinic morning
- followed by spirometry
- refer ID, Endo, Psy
- 2DE noon
D3
- bone scan + BMD
- OT chit if for scopes
- consent for scopes
- trace BL changes
D4
- grand rounds at 8am (ensure pt is in bed)
- KIV refer anaesthesia ( check with them )
- KIV scopes if any
- email CVM
D5
- await anaesthesia input