scholarly journals Blood preservation techniques in complex spine surgery: Illustrative case and review of therapeutic options

2021 ◽  
Vol 12 ◽  
pp. 515
Author(s):  
James P. Caruso ◽  
Mark N. Pernik ◽  
Zachary D. Johnson ◽  
Tarek Y. El Ahmadieh ◽  
Babatunde Ogunnaike ◽  
...  
Keyword(s):  
Blood Loss ◽  
Spine Surgery ◽  
Blood Donation ◽  
Autologous Blood ◽  
Deformity Correction ◽  
Illustrative Case ◽  
Blood Transfusions ◽  
Surgical Morbidity ◽  
Blood Preservation ◽  
Spinal Deformity Surgery

Background: Complex spine surgery predisposes patients to substantial levels of blood loss, which can increase the risk of surgical morbidity and mortality. Case Description: A 29-year-old achondroplastic male required thoracolumbar deformity correction. However, he refused potential allogeneic blood transfusions for religious reasons. He, therefore, underwent pre-operative autologous blood donation and consented to the use of the intraoperative cell salvage device. Immediately prior to the incision, he underwent acute normovolemic hemodilution. Throughout the case, we additionally utilized meticulous hemostasis. Postoperatively, he was supplemented with iron and erythropoietin and recovered well. When he required a revision procedure 3 months later, similar strategies were successfully employed. Conclusion: Numerous strategies exist pre-operatively, intraoperatively, and post-operatively to optimize blood loss management for patients who refuse blood transfusions but warrant major spinal deformity surgery.

scholarly journals Minimizing Blood Loss in Spine Surgery

2020 ◽  
Vol 10 (1_suppl) ◽  
pp. 71S-83S ◽  
Author(s):  
Christopher Mikhail ◽  
Zach Pennington ◽  
Paul M. Arnold ◽  
Darrel S. Brodke ◽  
Jens R. Chapman ◽  
...  
Keyword(s):  
Blood Loss ◽  
Spine Surgery ◽  
Current Literature ◽  
Blood Donation ◽  
Autologous Blood ◽  
Large Body ◽  
Preoperative Autologous Blood Donation ◽  
Multiple Modalities ◽  
Transfusion Requirements ◽  
Minimize Blood Loss

Study Design: Broad narrative review. Objective: To review and summarize the current literature on guidelines, outcomes, techniques and indications surrounding multiple modalities of minimizing blood loss in spine surgery. Methods: A thorough review of peer-reviewed literature was performed on the guidelines, outcomes, techniques, and indications for multiple modalities of minimizing blood loss in spine surgery. Results: There is a large body of literature that provides a consensus on guidelines regarding the appropriate timing of discontinuation of anticoagulation, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and herbal supplements prior to surgery. Additionally, there is a more heterogenous discussion the utility of preoperative autologous blood donation facilitated by erythropoietin and iron supplementation for healthy patients slated for procedures with high anticipated blood loss and for whom allogeneic transfusion is likely. Intraoperative maneuvers available to minimize blood loss include positioning and maintaining normothermia. Tranexamic acid (TXA), bipolar sealer electrocautery, and topical hemostatic agents, and hypotensive anesthesia (mean arterial pressure (MAP) <65 mm Hg) should be strongly considered in cases with larger exposures and higher anticipated blood loss. There is strong level 1 evidence for the use of TXA in spine surgery as it reduces the overall blood loss and transfusion requirements. Conclusion: As the volume and complexity of spinal procedures rise, intraoperative blood loss management has become a pivotal topic of research within the field. There are many tools for minimizing blood loss in patients undergoing spine surgery. The current literature supports combining techniques to use a cost- effective multimodal approach to minimize blood loss in the perioperative period.

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.

Some aspects of the development of blood donation in domestic health care

2020 ◽  
pp. 61-68
Author(s):  
M. Sharavina
Keyword(s):  
Health Care ◽  
Blood Loss ◽  
Blood Donation ◽  
Regulatory Framework ◽  
Blood Transfusions ◽  
Acute Blood Loss ◽  
Donated Blood

The first successful blood transfusions were aimed at saving lives of patients with acute blood loss, application of donated blood is much wider today. Expansion of informational work with donors, including development of understanding in a donor concerning importance of the donor program in patient’s life, as well as creation of the Blood Service, which is responsible for promotion, collection of blood and its components, their storage and transportation, contributes to the development of regular and ongoing donation. The author reviewed the regulatory framework for blood donation.

Blood transfusions in athletes. Old dogmas, new tricks

2006 ◽  
Vol 44 (12) ◽  
Author(s):  
Giuseppe Lippi ◽  
Giuseppe Banfi
Keyword(s):  
Blood Transfusion ◽  
Blood Donation ◽  
Autologous Blood ◽  
Effective Means ◽  
Blood Substitutes ◽  
Blood Transfusions ◽  
Dna Testing ◽  
Blood Doping ◽  
Gene Therapies ◽  
Human Erythropoietin

AbstractBlood doping consists of any illicit means used to increase and optimize oxygen delivery to the muscles and includes blood transfusions, administration of erythropoiesis-stimulating substances, blood substitutes, natural or artificial altitude facilities, and innovative gene therapies. The use of blood transfusion, an extremely straightforward, practical and effective means of increasing an athlete's red blood-cell supply in advance of competition, became rather popular in the 1970s, but it has suddenly declined following the widespread use of recombinant human erythropoietin among elite endurance athletes. Most recently, following implementation of reliable tests to screen for erythropoiesis-stimulating substances, blood transfusions have made a strong resurgence, as attested by several positive doping tests. Doping by blood transfusion can be classified as homologous, where the blood is infused into someone other than the donor, and autologous, where the blood donor and transfusion recipient are the same. The former case produces more clinically relevant side effects, but is easily detectable using current antidoping protocols based on erythrocyte phenotyping by flow cytometry and, eventually, erythrocyte genotyping by DNA testing. Since the donor and recipient blood are identical in autologous blood doping, this is less risky, though much more challenging to detect. Indirect strategies, relying on significant deviations from individual hematological profiles following autologous blood donation and reinfusion, are currently being investigated. For the time being, the storage of athletes' blood samples to allow testing and sanctioning of guilty athletes once a definitive test has been introduced may represent a reliable deterrent policy.Clin Chem Lab Med 2006;44:1395–402.

scholarly journals The efficacy and safety of intraoperative acute normovolaemic haemodilution in complex spine surgery in a private surgical facility in Ghana

2021 ◽  
Vol 55 (1) ◽  
pp. 2-8
Author(s):  
Irene Wulff ◽  
Henry O. Duah ◽  
Audrey Oteng-Yeboah ◽  
Henry O. Tutu ◽  
Kwadwo P. Yankey ◽  
...  
Keyword(s):  
Blood Loss ◽  
Spine Surgery ◽  
Autologous Blood ◽  
Allogeneic Blood ◽  
Spine Deformity ◽  
Allogeneic Transfusion ◽  
Spine Deformities ◽  
Acute Normovolaemic Haemodilution ◽  
Group 2 ◽  
Group 1

Objectives: To assess the safety and clinical benefits of intraoperative acute normovolaemic haemodilution (ANH) incomplex spine surgery. Design: Prospective comparative cohort studySetting: A private orthopaedic hospital in GhanaPatients: Seventy-six patients who underwent complex spine deformity surgeryInterventions: Patients were randomly assigned to two groups. 45 patients to the acute normovolaemic haemodilution(ANH) or Group 1 and 31patients to the non-ANH or Group 2. Following anesthetic administration and before incision, autologous blood was collected from patients in Group1 and was reinfused during/shortly after surgery while patients in Group2 were transfused with compatible allogeneic blood intraoperatively.Main Outcome Measures: Changes in haemodynamic parameters and incidence of allogeneic transfusions and related complications.Results: The mean age (years), gender ratio, deformity size and aetiology, fusion levels, and operative times were similar in both groups. Blood loss (ml) of patients in groups 1 and 2 were 1583ml± 830.48 vs 1623ml ± 681.34, p=0.82, respectively. The rate of allogeneic blood transfusion in groups 1 and 2 were 71% vs 80.65%, p=0.88, respectively. Haemoglobin levels (g/dL) in groups 1 and 2 were comparable in both groups at Post-operative Day (POD) 0 and POD 1. Incidence of minor allogeneic transfusion reaction was 1/45 vs 1/31, p=0.80, group-1 and group-2, respectively.Conclusion: Acute normovolaemic haemodilution can be safely performed in complex spine surgery in underserved regions. However, its use does not obviate allogeneic transfusion in patients with complex spine deformities in whom large volumes of blood loss is expected.

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