Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery

2007 ◽  
Vol 83 (5) ◽  
pp. A1
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Blood Conservation ◽  
Perioperative Blood Transfusion

The scope of the problem

Perfusion ◽  
1993 ◽  
Vol 8 (1_suppl) ◽  
pp. 1-5 ◽  
Author(s):  
Kenneth M Taylor
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Surgical Technique ◽  
Blood Transfusion ◽  
Cell Activation ◽  
Blood Product ◽  
Aminocaproic Acid ◽  
Blood Product Transfusion ◽  
Blood Conservation ◽  
Pharmacological Agents

Despite refinements in cardiac surgical technique, disorders of haemostasis remain a significant problem, reflecting the effects of cardiopulmonary bypass on blood cell activation and coagulation. Increased understanding of the dangers of blood and blood product transfusion have shifted the goals from blood replacement to blood conservation in cardiac surgery. Two approaches to blood conservation are used: autotransfusion and administration of pharmacological agents. These approaches may be complementary, but the latter approach- preventing or at least modifying the haemostatic disorder- may be preferable. This paper reviews some of the pharmacological agents that have been used in an attempt to conserve blood, including e-aminocaproic acid, desmopressin, prostacyclin, tranexamic acid, dipyridamole, and aprotinin. None of these agents has been able to eliminate the need for blood transfusion in all patients; aprotinin has been successful, however, in eliminating the need for transfusion in some patients and dramatically reducing the need in others.

scholarly journals Preoperative Hemoglobin Optimization in Jehovah's Witness Cardiovascular Surgery Patients with Anemia and Barriers to Care

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4954-4954
Author(s):  
Patricia Locantore-Ford ◽  
Evani Patel ◽  
Sarah Chen ◽  
Robert C Goodacre ◽  
Brianna Butler ◽  
...  
Keyword(s):  
Health Care ◽  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Care Providers ◽  
Blood Products ◽  
Blood Conservation ◽  
Preoperative Anemia ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
The Cost

Abstract Cardiac surgery has a risk for extensive blood loss which poses a particular challenge in individuals refusing blood transfusions. Additionally, preoperative anemia with a hemoglobin (Hb) below 13 g/dL in men and 12 g/dL in women is associated with increased short and long-term complications and mortality and increases the need for blood transfusion support. The current guidelines for perioperative anemia management recommend optimizing hemoglobin levels prior to surgery and utilizing blood conservation techniques during the procedure. At present red blood cell (RBC) transfusions during cardiac surgery are usually recommended when Hb levels are below 7-8 g/dL a restrictive transfusion strategy to reduce complications. However, the use of any RBC transfusions is associated with worse outcomes in cardiac surgery compared with those who do not receive transfusions. We have found that JW seek out quality health care and accept the vast majority of medical treatments once they are educated. The Transfusion Free Medicine Coordinator's role in the Anemia Clinic is to endorse clinical strategies for managing hemorrhage and anemia without blood transfusion. They educate and counsel the patients so they can decide as to what blood fractions and cell salvage techniques they will accept. We have found that some Health Care Providers are unaware that ESAs also contain albumin so JW patients may be given this product without that knowledge. The vast majority of patients will accept the use of ESAs but find the cost prohibitive. Jehovah's Witness patients have provided a natural case study for examining how well adjuvant therapies can improve preoperative anemia without transfusions and continue with good outcomes. Hb optimization is achieved through the use of intravenous iron and, if needed, erythropoiesis stimulating agents (ESAs). In Table 1 we highlight our single center data in which all cardiovascular surgeries were performed by a surgeon experienced in blood-conservation strategies. Our thirty-day re-admission rates for all patients was zero percent, compared to state-specific data, which estimates about an 11.7% rate of re-admission. The data illustrate the need to have a target Hb 13 or above to allow for the decline that may occur during the hospital stay. Of note no thromboembolic events have occurred with the use of an ESA in this group. Although ESAs are approved to optimize Hb in orthopedic surgery, they are not covered for cardiac surgery which has presented a significant challenge to patients who can not safely proceed to surgery until a target Hb between 13 to 15 g/dL is achieved. These data highlight the utility and safety associated with the use of ESAs for patients who do not accept blood products at an experienced Center for Transfusion-Free Medicine, such as ours. At this time, since insurance companies do not cover the cost of ESAs for patients needing life-saving cardiovascular operations, cost is a prohibitive barrier for patients. Unfortunately, it is not uncommon for patients to have to borrow money from others or set up payment plans. We hope that analyses like ours will help drive changes in reimbursement policies, particularly for patients who based on religious convictions, cannot receive blood products, and thus for whom pre-operative hemoglobin optimization is of utmost importance. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare. OffLabel Disclosure: Erythropoiesis-stimulating agent (ESA) are indicated for the treatment of anemia due to Chronic Kidney Disease in patients on dialysis and not on dialysis, Zidovudine in patients with HIV-infection, anemia due to myelosuppressive chemotherapy and reduction of allogeneic RBC transfusions in patients undergoing elective, noncardiac, nonvascular surgery

Perfusion: Part of the Perioperative Blood Transfusion and Blood Conservation Management Team

2008 ◽  
Vol 85 (1) ◽  
pp. 359 ◽  
Author(s):  
Robert A. Baker ◽  
Timothy A. Dickinson ◽  
Kenneth G. Shann ◽  
Donald S. Likosky ◽  
Allison Bednarski Spiwak
Keyword(s):  
Blood Transfusion ◽  
Conservation Management ◽  
Management Team ◽  
Blood Conservation ◽  
Perioperative Blood Transfusion

Guidelines for Perioperative Blood Transfusion and Conservation in Cardiac Surgery

2010 ◽  
Vol 111 (6) ◽  
pp. 1555-1559 ◽  
Author(s):  
Eugene A. Hessel ◽  
Jerrold H. Levy
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Perioperative Blood Transfusion

scholarly journals Blood Conservation and Hemostasis Management in Pediatric Cardiac Surgery

2021 ◽  
Vol 8 ◽  
Author(s):  
Roby Sebastian ◽  
M. Iqbal Ahmed
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Relative Size ◽  
Patient Characteristics ◽  
Pediatric Cardiac Surgery ◽  
Conservation Strategies ◽  
Blood Product Transfusion ◽  
Blood Conservation ◽  
Coagulation Management ◽  
Hemostatic System

Pediatric cardiac surgery is associated with significant perioperative blood loss needing blood product transfusion. Transfusion carries serious risks and implications on clinical outcomes in this vulnerable population. The need for transfusion is higher in children and is attributed to several factors including immaturity of the hemostatic system, hemodilution from the CPB circuit, excessive activation of the hemostatic system, and preoperative anticoagulant drugs. Other patient characteristics such as smaller relative size of the patient, higher metabolic and oxygen requirements make successful blood transfusion management extremely challenging in this population and require meticulous planning and multidisciplinary teamwork. In this narrative review we aim to summarize risks and complications associated with blood transfusion in pediatric cardiac surgery and also to summarize perioperative coagulation management and blood conservation strategies.

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