The Role of Thromboelastography in Directing Blood Product Usage in Infant Open Heart Surgery

2009 ◽  
Vol 4 (5) ◽  
pp. 282-290 ◽  
Author(s):  
Eric N. Mendeloff ◽  
George F. Glenn ◽  
Paul Tavakolian ◽  
Eugene Lin ◽  
Allison Leonard ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Blood Product ◽  
Open Heart Surgery ◽  
Fresh Frozen Plasma ◽  
Blood Component ◽  
Open Heart ◽  
Product Usage ◽  
Blood Component Therapy ◽  
Fresh Frozen

Objective Thromboelastography (TEG) measures the dynamics of clot formation in whole blood and provides data that can guide specific blood component therapy. This study analyzed whether the implementation of TEG affected blood product utilization and overall hemostasis in infants (6 months and younger) undergoing open heart surgery. Methods TEG values measured include R (time to fibrin formation), angle (fibrinogen formation), and MA (platelet function). Blood product usage, TEG values, and operative parameters were collected during surgery on 112 consecutive infants (66 acyanotic) undergoing open heart surgery within the first 6 months of life. Controls consisted of chart data on 70 consecutive patients (57 acyanotic) undergoing the same surgical procedures before implementation of TEG (pre-TEG). Results Using TEG, the pattern of blood product utilization changed. Compared with the pre-TEG era, TEG era patients demonstrated a significant increase in fresh frozen plasma usage intraoperatively (4.74 vs. 1.83 mL/kg; P < 0.001) and reduced postoperative use of platelets (1.69 vs. 3.74 mL/kg; P = 0.006) and cryoprecipitate (0.89 vs. 1.95 mL/kg; P = 0.149). Chest tube drainage was significantly reduced at 1, 2, and 24 hours in the TEG group. TEG angle and MA measurements suggest that fibrinogen and platelets of cyanotic patients are more sensitive to hemodilution than the acyanotic patients. Conclusions TEG allows for proactive, goal-directed blood component therapy with improved postoperative hemostasis in infants undergoing cardiopulmonary bypass.

The Role of Thromboelastography in Directing Blood Product Usage in Infant Open Heart Surgery

2009 ◽  
Vol 4 (5) ◽  
pp. 282-290
Author(s):  
Eric N. Mendeloff ◽  
George F. Glenn ◽  
Paul Tavakolian ◽  
Eugene Lin ◽  
Allison Leonard ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Blood Product ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Product Usage

Universal fresh frozen plasma (Uniplas): a safe product in open-heart surgery

2003 ◽  
Vol 29 (10) ◽  
pp. 1736-1743 ◽  
Author(s):  
Stein Tølløfsrud ◽  
Harald Noddeland ◽  
Jan Ludvig Svennevig ◽  
Gunnar Bentsen ◽  
Tom Eirik Mollnes ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Fresh Frozen Plasma ◽  
Open Heart ◽  
Safe Product ◽  
Fresh Frozen ◽  
Frozen Plasma

scholarly journals A Case of Postoperative Lung Injury Requiring a Large Amount of Fresh Frozen Plasma to Achieve Hemostasis during Open-heart Surgery

2016 ◽  
Vol 36 (3) ◽  
pp. 297-304
Author(s):  
Keiko OKAMURA ◽  
Junko ICHIKAWA ◽  
Mitsuharu KODAKA ◽  
Goro KANEKO ◽  
Mariko ONO ◽  
...  
Keyword(s):  
Lung Injury ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Fresh Frozen Plasma ◽  
Open Heart ◽  
Fresh Frozen ◽  
Frozen Plasma

scholarly journals Maximal Conservation and Minimal Usage of Blood Products in Open Heart Surgery

1980 ◽  
Vol 8 (2) ◽  
pp. 178-182 ◽  
Author(s):  
P. E. Newland ◽  
J. Pastoriza-Pinol ◽  
J. McMillan ◽  
B. F. Smith ◽  
G. R. Stirling
Keyword(s):  
Heart Surgery ◽  
Blood Product ◽  
Open Heart Surgery ◽  
Blood Bank ◽  
Open Heart ◽  
Blood Products ◽  
Blood Conservation ◽  
Simple Method ◽  
Product Usage ◽  
Intraoperative Autotransfusion

Open heart surgery has previously been associated with the use of large volumes of blood products. This paper describes methods of blood conservation and a simple method of intraoperative autotransfusion that together have resulted in minimal blood product usage in elective open heart surgery cases. This has reduced our dependence on blood bank supplies for the performance of elective open heart surgery.

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.

Identification of Wasted Blood Products at Staten Island University Hospital in 2020 and Institutional Efforts to Reduce Wastage

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S156-S157
Author(s):  
M Toprak ◽  
I M Asuzu ◽  
G Morvillo ◽  
F Kiran ◽  
B Chae ◽  
...  
Keyword(s):  
Shelf Life ◽  
Blood Product ◽  
Low Cost ◽  
Fresh Frozen Plasma ◽  
University Hospital ◽  
Blood Component ◽  
Blood Products ◽  
Staten Island ◽  
Team Members ◽  
Fresh Frozen

Abstract Introduction/Objective Blood products are precious resources obtained from donors who donate with the intention to help people. These blood products however do not always go to the patients, instead sometimes ending up in the waste. It is inevitable to have some degree of the wastage due to limited blood product shelf life, the inherent need to have stock on hand at all times, and the often unpredictable demand of these products. However, it is possible to minimize the wastage of blood products with careful management of inventories, proper documentation, and education1. In this study, we aim to identify the amount and cost of wasted blood products at Staten Island University Hospital in 2020, the reasons behind the wastage, and solutions to reduce the wastage. Methods/Case Report A retrospective statistical analysis of blood product waste data in 2020 was performed manually with Microsoft Excel. Wastage rate and average cost was calculated, the reasons behind the wastage were identified, and low cost interventions to reduce wastage were planned. Results (if a Case Study enter NA) Total number of the wasted blood product is 425 which represents 3.8% of the total inventory at a total cost of $ 97,309.46 which does not include the hours spend by the lab personnel for the wasted products. The most wasted blood component is fresh frozen plasma (FFP) (Table 1). Thawing the frozen blood products (FFP and cryoprecipitate) significantly shortens the shelf life and triggers a lot of wastage through expiration (Table 2). 32.5 % of the wasted products are wasted due to expiration on the shelf (Diagram 1). Other reasons for the wastage includes patient unreadiness, patient refusal, late return of unused products etc. (Graph 1). Conclusion Educating clinical and laboratory team members about the reasons for wasted blood products and strategies to reduce it might significantly reduce the wastage. Appropriate activation and immediate deactivation of massive transfusion protocol (MTP) would be one of the most important aspect of this education. Expired thawed blood product is the largest contributor to wastage, and MTP is the main reason for thawing. Preventing unnecessary MTP activation minimizes over-thawing and therefore minimizes the expiration and wastage. Documentation of the wasted blood product should be improved to better identify the reasons behind wastage.

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