scholarly journals Bleeding complications associated with cardiopulmonary bypass

Blood ◽  
1990 ◽  
Vol 76 (9) ◽  
pp. 1680-1697 ◽  
Author(s):  
RC Woodman ◽  
LA Harker
Keyword(s):  
Blood Donation ◽  
Bleeding Complications ◽  
Blood Products ◽  
Platelet Dysfunction ◽  
Homologous Blood ◽  
Excessive Bleeding ◽  
Shed Blood ◽  
Homologous Blood Transfusion ◽  
The Many ◽  
Pharmacologic Agents

Abstract Bleeding after CPB has been difficult to characterize and its treatment equally difficult to standardize. The complexity of this problem is related to the hemostatic process, the technical variations in the operative procedures, and the many uncontrolled variables associated with CPB, including the effects of anesthetic or pharmacologic agents, the nature of the priming solution, hemodilution, hypothermia, the type of oxygenator, and the use of transfused blood products. Although there are multiple and generally predictable complex changes in the hemostatic mechanism during CPB, the temporary loss of platelet function is the most common and clinically relevant. This transient platelet dysfunction occurs in all patients undergoing CPB; however, it only causes excessive bleeding in a small percentage of patients. Unfortunately, it has not yet been possible to predict which patients will develop hemorrhagic complications, although prolonged pump times are a contributing risk factor. Over the past decade there has been extensive investigation into the management of bleeding associated with CPB, provoked primarily by the increased awareness of transfusion- transmitted viral diseases and the inappropriately excessive use of homologous blood products. Several approaches to autotransfusion of shed blood and autologus blood donation have been developed to minimize perioperative homologous blood transfusion. Pharmacologic agents such as desmopressin, aprotinin, and topical fibrin glues have also been introduced to improve hemostasis during CPB. The protease inhibitor aprotinin is particularly promising in the reduction of bleeding associated with CPB when given prophylactically. Aprotinin may provide new insights into the mechanism of CPB-induced platelet dysfunction. Desmopressin is indicated only for the treatment of bleeding after CPB. The management of bleeding associated with CPB will undoubtedly

scholarly journals Bleeding complications associated with cardiopulmonary bypass

Blood ◽  
1990 ◽  
Vol 76 (9) ◽  
pp. 1680-1697 ◽  
Author(s):  
RC Woodman ◽  
LA Harker
Keyword(s):  
Blood Donation ◽  
Bleeding Complications ◽  
Blood Products ◽  
Platelet Dysfunction ◽  
Homologous Blood ◽  
Excessive Bleeding ◽  
Shed Blood ◽  
Homologous Blood Transfusion ◽  
The Many ◽  
Pharmacologic Agents

Bleeding after CPB has been difficult to characterize and its treatment equally difficult to standardize. The complexity of this problem is related to the hemostatic process, the technical variations in the operative procedures, and the many uncontrolled variables associated with CPB, including the effects of anesthetic or pharmacologic agents, the nature of the priming solution, hemodilution, hypothermia, the type of oxygenator, and the use of transfused blood products. Although there are multiple and generally predictable complex changes in the hemostatic mechanism during CPB, the temporary loss of platelet function is the most common and clinically relevant. This transient platelet dysfunction occurs in all patients undergoing CPB; however, it only causes excessive bleeding in a small percentage of patients. Unfortunately, it has not yet been possible to predict which patients will develop hemorrhagic complications, although prolonged pump times are a contributing risk factor. Over the past decade there has been extensive investigation into the management of bleeding associated with CPB, provoked primarily by the increased awareness of transfusion- transmitted viral diseases and the inappropriately excessive use of homologous blood products. Several approaches to autotransfusion of shed blood and autologus blood donation have been developed to minimize perioperative homologous blood transfusion. Pharmacologic agents such as desmopressin, aprotinin, and topical fibrin glues have also been introduced to improve hemostasis during CPB. The protease inhibitor aprotinin is particularly promising in the reduction of bleeding associated with CPB when given prophylactically. Aprotinin may provide new insights into the mechanism of CPB-induced platelet dysfunction. Desmopressin is indicated only for the treatment of bleeding after CPB. The management of bleeding associated with CPB will undoubtedly

Bloodless cardiac surgery and the pediatric patient: a case study

Perfusion ◽  
2008 ◽  
Vol 23 (2) ◽  
pp. 131-134 ◽  
Author(s):  
AL Ging ◽  
JR St. Onge ◽  
DC Fitzgerald ◽  
LR Collazo ◽  
LS Bower ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Near Infrared ◽  
Cell Mass ◽  
Male Infant ◽  
Pediatric Cardiac Surgery ◽  
Blood Products ◽  
Homologous Blood ◽  
Circulating Blood Volume ◽  
Homologous Blood Transfusion ◽  
Priming Volume

Peri-operative transfusion of blood or blood products is associated with increased morbidity and mortality after cardiac surgery. However, excessive hemodilution as a result of avoiding the use of homologous blood products can also lead to decreased oxygen delivery to vital end organs and dilutional coagulopathy. This is particularly challenging in pediatric cardiac surgery where there is a large discrepancy between the patient circulating blood volume and the priming volume of the cardiopulmonary bypass (CPB) circuit. Strategies to avoid the use of homologous blood products during pediatric cardiac surgery must also incorporate miniaturization of the CPB circuit and other bypass techniques in order to avoid problems with excessive hemodilution. We report a 5.9 kg male infant who underwent successful surgical correction of a ventricular septal defect without the use of homologous blood transfusion. Our strategies included the pre-operative administration of erythropoietin and iron to increase red blood cell mass, acute normovolemic hemodilution (ANH) before the institution of CPB, retrograde autologous priming (RAP), cell salvage, continuous ultrafiltration, vacuum-assisted venous drainage to minimize the circuit size and priming volume, and the use of near infrared spectroscopy (NIRS) to monitor the patient during the entire procedure. The utilization of these strategies is now standard for our entire pediatric cardiac surgical population.

Blood products are used to treat a multitude of diseases, so the blood transfusion system needs to be enhanced. CRISPR/Cas9 has made it viable to make HLA class I-deleted blood products to avoid rejection

2021 ◽  
Author(s):  
Moataz Dowaidar
Keyword(s):  
Blood Transfusion ◽  
Blood Donation ◽  
Es Cells ◽  
Scale Up ◽  
Embryonic Stem ◽  
Hla Class I ◽  
Class I ◽  
Blood Products ◽  
Expiry Date ◽  
Ips Cell

In adults, normal hematopoiesis occurs in the bone marrow, producing leukocytes, red blood cells, and platelets. Recently, megakaryocytes have been found in mouse lungs and spleen, where they release platelets by blood flow force. Blood products are used to treat a multitude of diseases and conditions that generate cytopenia. The blood transfusion system must be enhanced due to a drop in blood donors due to low birth rate and changing attitudes among young people, pathogen contamination, and rising demand due to chronic blood diseases that are prevalent among the elderly. Pluripotent stem cells, such as embryonic stem (ES) cells, may proliferate in vitro indefinitely and are a prospective source for blood transfusions to replace blood donations.Platelet preparations can be maintained at room temperature to sustain platelet function, but only have a statutory expiry date of five days. Platelets are anucleate cells, thus irradiation before blood donation can lessen the risk of iPS cell infection. Effective treatment requires HLA-compatible platelet transfusions, although supply limits often leave patients underserved. CRISPR/Cas9 has made it viable to make HLA class I-deleted blood products to avoid rejection and lower the odds of platelet-expressed human leukocyte antigen Class I cancer-causing iPS cells (HLA-I). This article discusses the production of megakaryocyte cell lines, bioreactors, and scale-up cultures, as well as identifying viable drugs in manufacturing. HLA-null, iPSC-derived platelet products' universal potential will also be explored.

These studies indicate that homologous blood transfusion affects the outcome of clinical diseases in both beneficial and adverse ways. Experimental situations are not suitable for randomized clinical trials - transfusions cannot be given to prevent the onset of diabetes or wound strength measured in man following receipt of homologous or autologous blood. These experimental observations indicate that the outcomes of numerous clinical diseases which have not been studied may be manipulated by the use of homologous blood or that transfusion should be avoided. Several studies indicate that changes in immune function following transfusion are permanent. The number of clinical phenomena associated with immune suppression and attributable to blood transfusion is unknown. SUMMARY Given the evidence presented here it would be foolish to suggest that transfusion of homologous blood has no immunologic consequences for the recipient. Blood transfusion is the oldest form of transplant - no one would argue that transplantation between unrelated individuals has no influience on the immune system. In organ transplantation the immunologic sequelae are permanent and there is evidence that the same is true following homologous blood transfusion. Lymphocytopenia is present one year following surgery for Crohn's disease if patients receive perioperative blood transfusion (43). Colorectal cancer patients transfused more than seven years prior to diagnosis have significantly reduced numbers of lymphocytes and lower natural killer cytotoxicity than colorectal cancer patients who have never been transfused (44). Transfusion of neonates causes suppression of lymphocyte reactivity which is still demonstrable 25 to 30 years later (45). There is evidence that transfusion at any time prior to elective surgery increases susceptibility to infectious complications (14) and otherwise healthy transfused individuals may be at increased risk of developing malignancies (46). All the longterm consequences of blood transfusion are not negative: Survival of transplants is prolonged by pretransplant transfusion and some women suffering from recurrent spontaneous abortion can deliver at term if previously transfused with their spouse's leukocytes. In the future we will be able to transfuse blood without causing immune perterbations and the consequent clinical phenomena. Studies presented here suggest that removal of donor leukocytes reduces the risk of infection and cancer recurrence. The technology has not reached the point of reducing the leukocyte number in transfused blood below 10^/unit. An alternative which is increasingly being utilized is autologous blood programs. Physicians are discovering that patients tolerate hemoglobin levels which were previously unacceptably low and many patients prefer being anemic over the risks of receiving homologous blood. Since transfusion is an identifier of high cost hospitalized patients, alternatives to routine blood use are being studied in hopes of safely reducing the costs of transfusion. REFERENCES 1. Jubert AV, Lee ET, Hersh EM, McBride CM. J Surg Res 15:399-403, 1973. 2. M 19 u4n ( s3t ) e3r4A6-M 35 , 2 W , i1n9c8h1u . rch RA, Keane RM, Shatney CH, Ernst CB, Nuidema GD. Ann Surg

1995 ◽  
pp. 300-300
Keyword(s):  
Colorectal Cancer ◽  
Blood Transfusion ◽  
Cancer Patients ◽  
Randomized Clinical Trials ◽  
Elective Surgery ◽  
Autologous Blood ◽  
Homologous Blood ◽  
Homologous Blood Transfusion ◽  
One Year ◽  
Colorectal Cancer Patients
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