A Study of Desmopressin and Blood Loss during Spinal Fusion for Neuromuscular Scoliosis 

1997 ◽  
Vol 87 (2) ◽  
pp. 260-267 ◽  
Author(s):  
Mary C. Theroux ◽  
David H. Corddry ◽  
Amy E. Tietz ◽  
Freeman Miller ◽  
Joseph D. Peoples ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Blood Loss ◽  
Spinal Fusion ◽  
Normal Saline ◽  
Controlled Trial ◽  
Systolic Pressure ◽  
Fresh Frozen Plasma ◽  
Estimated Blood Loss ◽  
Fresh Frozen ◽  
Medical Histories

Background Studies examining the use of desmopressin acetate (DDAVP) have shown variable results in DDAVP's efficacy for reducing blood loss. Studies of adults having cardiac surgery and of children having spinal fusion have suggested that patients with complicated medical histories and complex surgical procedures may benefit from use of DDAVP. Therefore, this study was designed to examine the homeostatic effects of DDAVP in children with severe cerebral palsy undergoing spinal fusion. Methods A randomized, double-blinded, and placebo-controlled trial of DDAVP was designed to enroll 40 patients. However, termination of the study was advised by the Institutional Review Board after 21 patients were enrolled. All patients had spastic quadriplegic-type cerebral palsy and were randomly assigned to one of two groups. The DDAVP group received 0.3 microg/kg DDAVP in 100 ml normal saline, and the placebo group received normal saline alone. All patients were anesthetized with nitrous oxide, oxygen, isoflurane, and fentanyl. Factor VIIIC and von Willebrand's factor (vWF) concentrations were measured in blood drawn before DDAVP infusion and 1 h after infusion. Blood pressure was maintained at a systolic pressure of less than 100 mmHg. Use of crystalloids, packed erythrocytes, platelets, and fresh frozen plasma were based on criteria established by protocol. Estimated blood loss was assessed by weighing sponges and measuring suctioned blood from canisters. Results Estimated blood loss (intraoperative and postoperative) and amount of packed erythrocytes transfused were similar for the DDAVP and placebo groups. Concentrations of both factor VIIIC and vWF were significantly greater after DDAVP infusion when compared with concentrations after placebo infusion. Conclusions In the children who had complex spinal fusion, there was no difference in estimated blood loss between those who received DDAVP and those who received a placebo. Administration of DDAVP significantly increased factor VIIIC and vWF levels.

scholarly journals Use of blood-sparing surgical techniques and transfusion algorithms: association with decreased blood administration in children undergoing primary open craniosynostosis repair

2015 ◽  
Vol 16 (5) ◽  
pp. 556-563 ◽  
Author(s):  
Thanh T. Nguyen ◽  
Sarah Hill ◽  
Thomas M. Austin ◽  
Gina M. Whitney ◽  
John C. Wellons ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Postoperative Period ◽  
Surgical Techniques ◽  
Perioperative Period ◽  
Fresh Frozen Plasma ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Frozen Plasma

OBJECT Craniofacial reconstruction surgery (CFR) is often associated with significant blood loss, coagulopathy, and perioperative blood transfusion. Due to transfusion risks, many different approaches have been used to decrease allogeneic blood transfusion for these patients during the perioperative period. Protocols have decreased blood administration during the perioperative period for many types of surgeries. The object of this study was to determine if a protocol involving blood-sparing surgical techniques and a transfusion algorithm decreased intraoperative blood transfusion and blood loss. METHODS A protocol using transfusion algorithms and implementation of blood-sparing surgical techniques for CFR was implemented at Vanderbilt University on January 1, 2013. Following Institutional Review Board approval, blood loss and transfusion data were gathered retrospectively on all children undergoing primary open CFR, using the protocol, for the calendar year 2013. This postprotocol cohort was compared with a preprotocol cohort, which consisted of all children undergoing primary open CFR during the previous calendar year, 2012. RESULTS There were 41 patients in the preprotocol and 39 in the postprotocol cohort. There was no statistical difference between the demographics of the 2 groups. When compared with the preprotocol cohort, intraoperative packed red blood cell transfusion volume decreased from 36.9 ± 21.2 ml/kg to 19.2 ± 10.9 ml/kg (p = 0.0001), whereas fresh-frozen plasma transfusion decreased from 26.8 ± 25.4 ml/kg to 1.5 ± 5.7 ml/kg (p < 0.0001) following implementation of the protocol. Furthermore, estimated blood loss decreased from 64.2 ± 32.4 ml/kg to 52.3 ± 33.3 ml/kg (p = 0.015). Use of fresh-frozen plasma in the postoperative period also decreased when compared with the period before implementation of the protocol. There was no significant difference in morbidity and mortality between the 2 groups. CONCLUSIONS The results of this study suggested that using a multidisciplinary protocol consisting of transfusion algorithms and implementation of blood-sparing surgical techniques during major CFR in pediatric patients is associated with reduced intraoperative administration of blood product, without shifting the transfusion burden to the postoperative period.

Preoperative hematocrit and platelet count are associated with blood loss during spinal fusion for children with neuromuscular scoliosis

2021 ◽  
pp. 175045892096263
Author(s):  
Margaret O Lewen ◽  
Jay Berry ◽  
Connor Johnson ◽  
Rachael Grace ◽  
Laurie Glader ◽  
...  
Keyword(s):  
Platelet Count ◽  
Blood Loss ◽  
Spinal Fusion ◽  
Regression Trees ◽  
Classification And Regression Trees ◽  
Neuromuscular Scoliosis ◽  
Independent Variables ◽  
Estimated Blood Loss ◽  
Laboratory Results ◽  
Classification And Regression

Aim To assess the relationship of preoperative hematology laboratory results with intraoperative estimated blood loss and transfusion volumes during posterior spinal fusion for pediatric neuromuscular scoliosis. Methods Retrospective chart review of 179 children with neuromuscular scoliosis undergoing spinal fusion at a tertiary children’s hospital between 2012 and 2017. The main outcome measure was estimated blood loss. Secondary outcomes were volumes of packed red blood cells, fresh frozen plasma, and platelets transfused intraoperatively. Independent variables were preoperative blood counts, coagulation studies, and demographic and surgical characteristics. Relationships between estimated blood loss, transfusion volumes, and independent variables were assessed using bivariable analyses. Classification and Regression Trees were used to identify variables most strongly correlated with outcomes. Results In bivariable analyses, increased estimated blood loss was significantly associated with higher preoperative hematocrit and lower preoperative platelet count but not with abnormal coagulation studies. Preoperative laboratory results were not associated with intraoperative transfusion volumes. In Classification and Regression Trees analysis, binary splits associated with the largest increase in estimated blood loss were hematocrit ≥44% vs. <44% and platelets ≥308 vs. <308 × 109/L. Conclusions Preoperative blood counts may identify patients at risk of increased bleeding, though do not predict intraoperative transfusion requirements. Abnormal coagulation studies often prompted preoperative intervention but were not associated with increased intraoperative bleeding or transfusion needs.

Necrotizing Enterocolitis

1982 ◽  
Vol 4 (1) ◽  
pp. 27-27
Keyword(s):  
Necrotizing Enterocolitis ◽  
Normal Saline ◽  
Exchange Transfusion ◽  
Isotonic Saline ◽  
Fresh Frozen Plasma ◽  
Fresh Frozen ◽  
Plasma Expanders ◽  
Immune Factors ◽  
Frozen Plasma

A reader commented:"In the October issue of PIR(3:121, 1981), in "Necrotizing Entercolitis" Burg and Polin recommend partial exchange transfusion for high hematocrit, using normal saline. I was taught to use fresh frozen plasma or albumin for partial exchanges. What are the advantages, if any, of isotonic saline over plasma or albumin?" Drs Burg and Polin reply: "Although, theoretical arguments can be made for use of fresh frozen plasma to reduce the hematocrit, either saline, synthetic plasma expanders, or 5% albumin would be suitable. Much of the albumin given in plasma or synthetic solutions quickly leaks out of the newborn infant's intravascular compartment. The purpose of a partial exchange transfusion in neonatal polycythemia is to lower the hematocrit and lessen the hyperviscosity; it is not to replace coagulation or immune factors or remove toxins. Saline would be just as satisfactory as plasma for this purpose."

The bleeding patient

2020 ◽  
pp. 403-428
Author(s):  
Anne Craig ◽  
Anthea Hatfield
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Disseminated Intravascular Coagulation ◽  
Oxygen Supply ◽  
Fresh Frozen Plasma ◽  
Blood Transfusions ◽  
Massive Blood Transfusion ◽  
Intravascular Coagulation ◽  
Fresh Frozen ◽  
Frozen Plasma

Part one of this chapter tells you about the physiology of blood and oxygen supply, about anaemia and tissue hypoxia, and the physiology of coagulation. Drugs that interfere with clotting are discussed. Bleeding, coagulation, and platelet disorders are covered as well as disseminated intravascular coagulation. Part two is concerned with bleeding in the recovery room: how to cope with rapid blood loss, managing ongoing blood loss, and how to use clotting profiles to guide treatment. There is also a section covering blood transfusion, blood groups and typing. Massive blood transfusion is clearly described, there are guidelines about when to use fresh frozen plasma, when to use platelets, and when to use cryoprecipitate. The final section of the chapter is about problems with blood transfusions.

scholarly journals Infusion-transfusion therapy in the treatment of patients with acute bleedings from the upper gastrointestinal tract

2012 ◽  
Vol 93 (2) ◽  
pp. 390-394
Author(s):  
G R Khalikova ◽  
I S Malkov ◽  
V V Fattakhov ◽  
M N Nasrullaev
Keyword(s):  
Gastrointestinal Tract ◽  
Blood Loss ◽  
Fresh Frozen Plasma ◽  
Endoscopic Hemostasis ◽  
Upper Gastrointestinal Tract ◽  
Infusion Therapy ◽  
Transfusion Therapy ◽  
Fresh Frozen ◽  
Upper Gastrointestinal ◽  
Frozen Plasma

Aim. To improve the treatment outcomes of patients with acute bleedings from the upper gastrointestinal tract by improving methods of endoscopic hemostasis and prediction of disease recurrence. Methods. The results of treatment of 776 patients with bleedings from the upper gastrointestinal tract have been analyzed. Methods of conservative therapy, endoscopic hemostasis and surgical treatment were used in combination with infusion therapy. Results. Established was the necessity of a differentiated method of endoscopic hemostasis, depending on the localization of the bleeding source, its intensity and effectiveness during ongoing bleedings. Infusion therapy should be initiated from the moment of verification of the diagnosis of acute bleeding from the upper gastrointestinal tract, regardless of the degree of blood loss, and already in the hospital’s emergency department. In cases of mild bleedings the infusion volume is 800-1000 ml: 80% crystalloids + 20% of colloids. The volume of infusion in moderate blood loss is 1500-2300 ml: 60% crystalloids + 20 colloids % + 20% fresh frozen plasma. The volume of infusion in severe blood loss is 2700 ml and more: 20% of crystalloids + 30% colloids + 30% fresh frozen plasma + 20% erythrocyte mass. Replacement therapy requires careful monitoring of the hemodynamic parameters and infusion load due to the unpredictability of body reactions to blood loss and its replacement. In the absence of an effect of conservative treatment within 6-24 hours an emergency operation is indicated with the choice of an optimal method based on an assessment of the physiological status on a POSSUM scale of assessment. Conclusion. Implementation of substitution therapy, which correlates to the degree of blood loss, critically important in order to eliminate ischemia of the wall of the gastrointestinal tract and prevent recurrence of bleeding; the usage of new approaches to the prediction of recurrent bleedings and improvement of methods of endoscopic haemostasis reduces the frequency of their occurrence, duration of in-hospital stay of patients and postoperative mortality.

The bleeding patient

2014 ◽  
Author(s):  
Anthea Hatfield
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Disseminated Intravascular Coagulation ◽  
Oxygen Supply ◽  
Final Section ◽  
Fresh Frozen Plasma ◽  
Blood Transfusions ◽  
Massive Blood Transfusion ◽  
Fresh Frozen ◽  
Frozen Plasma

Part one of this chapter tells you about the physiology of blood and oxygen supply, about anaemia and tissue hypoxia, and the physiology of coagulation. Drugs that interfere with clotting are discussed. Bleeding, coagulation, and platelet disorders are covered as well as disseminated intravascular coagulation. Part two is concerned with bleeding in the recovery room: how to cope with rapid blood loss, managing ongoing blood loss, and how to use clotting profiles to guide treatment. There is also a section covering blood transfusion, blood groups and typing. Massive blood transfusion is clearly described, there are guidelines about when to use fresh frozen plasma, when to use platelets, and when to use cryoprecipitate. The final section of the chapter is about problems with blood transfusions.

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