Blood-product usage in cardiac surgery

1989 ◽  
Vol 3 (6) ◽  
pp. 776-784 ◽  
Author(s):  
Joan Uehlinger ◽  
Louis M. Aledort
Keyword(s):  
Cardiac Surgery ◽  
Blood Product ◽  
Product Usage

Management of Intraoperative Fluid Balance and Blood Conservation Techniques in Adult Cardiac Surgery

2011 ◽  
Vol 14 (1) ◽  
pp. 28 ◽  
Author(s):  
George Vretzakis ◽  
Athina Kleitsaki ◽  
Diamanto Aretha ◽  
Menelaos Karanikolas
Keyword(s):  
Cardiac Surgery ◽  
Blood Cell ◽  
Fluid Balance ◽  
Blood Product ◽  
Blood Donation ◽  
Autologous Blood ◽  
Small Body ◽  
Risk Indicators ◽  
Blood Transfusions ◽  
Blood Conservation

Blood transfusions are associated with adverse physiologic effects and increased cost, and therefore reduction of blood product use during surgery is a desirable goal for all patients. Cardiac surgery is a major consumer of donor blood products, especially when cardiopulmonary bypass (CPB) is used, because hematocrit drops precipitously during CPB due to blood loss and blood cell dilution. Advanced age, low preoperative red blood cell volume (preoperative anemia or small body size), preoperative antiplatelet or antithrombotic drugs, complex or re-operative procedures or emergency operations, and patient comorbidities were identified as important transfusion risk indicators in a report recently published by the Society of Cardiovascular Anesthesiologists. This report also identified several pre- and intraoperative interventions that may help reduce blood transfusions, including off-pump procedures, preoperative autologous blood donation, normovolemic hemodilution, and routine cell saver use.A multimodal approach to blood conservation, with highrisk patients receiving all available interventions, may help preserve vital organ perfusion and reduce blood product utilization. In addition, because positive intravenous fluid balance is a significant factor affecting hemodilution during cardiac surgery, especially when CPB is used, strategies aimed at limiting intraoperative fluid balance positiveness may also lead to reduced blood product utilization.This review discusses currently available techniques that can be used intraoperatively in an attempt to avoid or minimize fluid balance positiveness, to preserve the patient's own red blood cells, and to decrease blood product utilization during cardiac surgery.

Temporal changes in blood product usage in preterm neonates born at less than 30 weeks' gestation in Canada

Transfusion ◽  
2015 ◽  
Vol 55 (6) ◽  
pp. 1340-1346 ◽  
Author(s):  
Amy K. Keir ◽  
Junmin Yang ◽  
Adele Harrison ◽  
Ermelinda Pelausa ◽  
Prakesh S. Shah ◽  
...  
Keyword(s):  
Blood Product ◽  
Temporal Changes ◽  
Preterm Neonates ◽  
Product Usage

scholarly journals Geographic differences in hemophilia-associated AIDS incidence in Pennsylvania. By the Pennsylvania AIDS Surveillance Study Group

Blood ◽  
1987 ◽  
Vol 70 (4) ◽  
pp. 1208-1210 ◽  
Keyword(s):  
Blood Product ◽  
Fresh Frozen Plasma ◽  
Factor Ix ◽  
Antibody Prevalence ◽  
Product Usage ◽  
Fresh Frozen ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome ◽  
Hemophilia Treatment Centers ◽  
Frozen Plasma

A 1986 survey of seven hemophilia treatment centers in Pennsylvania (PA) has revealed that 22 hemophiliacs residing in PA have developed the acquired immunodeficiency syndrome (AIDS), representing 9.2% of the total 238 United States hemophiliac AIDS cases. These 22 included ten (45.5%) from western PA (W-PA), eleven (50.0%) from central PA (C-PA), and one (0.5%) from eastern PA (E-PA). The HIV antibody prevalence for these three geographic groups is comparable, with 84 of 178 (47.2%) of hemophiliacs in W-PA seropositive, 102 of 182 (56.0%) in C-PA seropositive, and 105 of 177 (59.3%) in E-PA seropositive. Blood product usage for these three areas is comparable: 47.8 X 10(3) (W-PA) v 43.9 (C-PA) v 53.3 (E-PA) units factor VIII concentrate per patient per year; 36.5 v 24.5 v 33.7 for factor IX concentrate; 8.4 v 4.7 v 7.7 for cryoprecipitate; and 1.3 v 2.7 v 1.0 for fresh frozen plasma, respectively. These data demonstrate a geographic variation in hemophilia AIDS incidence in PA, with a tenfold higher incidence in W- PA and C-PA than E-PA, which is unrelated to differences in HIV antibody prevalence, patient blood product usage, or inaccuracies in AIDS case reporting. Because of the greater than or equal to 5 year median latency between HIV infection and development of AIDS, the AIDS incidence will continue to change, but other factors appear to be operative in the development of AIDS in hemophiliacs.

scholarly journals The Impact of Perioperative Viscoelastic Test Application on Blood Product Usage and Outcome in Cardiac Surgery; Regional Cardiac Surgery Center Experience

2021 ◽  
Author(s):  
Murat Aksun ◽  
Saliha Aksun ◽  
Mehmet Ali Çoşar ◽  
Elif Neziroğlu ◽  
Senem Girgin ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Clinical Experience ◽  
Heart Surgery ◽  
Blood Product ◽  
Open Heart Surgery ◽  
Control Group ◽  
Open Heart ◽  
Blood Products ◽  
Product Use ◽  
The Impact

Objective: Thromboelastography (TEG) is a diagnostic modality that gives information about coagulation. Despite all blood-preserving precautions in open heart surgery there are blood losses and the use of blood and blood products becomes inevitable. TEG is mostly not available in every center and habits, trends and clinical experience in blood use create the possibility of causing unnecessary use of blood and blood products. In this study, it was aimed to determine the effect of the use of thromboelastography on the use of blood and blood products in cardiac surgery. Methods: Two hundred patients between 18-70 years old who underwent open heart surgery were included in the study. After the cardiopulmonary bypass (CPB), the cases were confirmed to have an Activated Clotting Time (ACT) value in the range of 120-150 sec after protamine administration. In 100 patients in the TEG group, the coagulation status was evaluated with TEG and it was decided how to apply blood and blood product use. Blood and blood product use was applied to 100 patients in the control group based on clinical experience and foresight. The total amount of blood and blood product used, fluid balance, need for inotropics, mechanical ventilator time, complications, duration of intensive care and discharge times were recorded. Results: Use of Fresh Frozen Plasma (FFP) at the after CPB in the TEG group was statistically significantly lower than that of the control group FFP (p<0.05). Postoperative FFP and postoperative platelet use in the study group were statistically significantly lower than in the postoperative FFP and postoperative platelet values of the control group (p <0.05). Conclusion: The use of thromboelastography is a very useful monitoring in terms of reducing FFP use after CPB and reducing FFP and platelet usage in the postoperative period. In this way, the unnecessary use of blood and blood products can be prevented.

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.

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