scholarly journals Massive blood loss in pediatric practice

2020 ◽  
Vol 65 (1) ◽  
pp. 70-86 ◽  
Author(s):  
K. V. Pshenisnov ◽  
Yu. S. Aleksandrovich
Keyword(s):  
Blood Loss ◽  
High Efficiency ◽  
Underlying Disease ◽  
Severe Trauma ◽  
Multicenter Studies ◽  
Circulating Blood Volume ◽  
Surgical Interventions ◽  
Massive Blood Loss ◽  
Pubmed Database ◽  
Causes Of Deaths

Background. Massive blood loss is one of the main causes of deaths and complications both in patients requiring extensive surgical interventions and those with severe trauma.Aim. To analyse available publications devoted to the definition, pathogenesis, diagnosis and intensive care of acute massive blood loss in children.Materials and methods. The conducted analysis involved 102 publications by Russian and foreign authors from the PubMed database devoted to the problem of massive blood loss in children.General findings. The paper presents modern definitions of massive blood loss in children. Special attention is paid to the pathogenesis, diagnosis and treatment of massive blood loss in severe trauma cases. The principles of correcting the deficiency of circulating blood volume, the use of inotropic and vasopressor drugs, as well as the elimination of severe anemia and hemostasis disorders, are considered. Publications devoted to the search for an optimal ratio of globular and plasma volumes during the transfusion of blood components are reviewed. It is shown that the reviewed publications report conflicting opinions regarding the use of antifibrinolytic medications. At the same time, the high efficiency of tranexamic acid and its positive effect on the functional outcome in patients with severe trauma is demonstrated. In order to optimize approaches to the management of massive blood loss in children, additional multicenter studies are required. These studies should consider the effect of the underlying disease that caused massive blood loss, as well as the treatment and diagnostic capacity of hospitals.

scholarly journals BLEEDINGS IN THE HIGH-RISK GROUP OBSTETRIC HOSPITAL

2018 ◽  
Vol 5 (1) ◽  
pp. 37-40
Author(s):  
Elena M. Guseva
Keyword(s):  
High Risk ◽  
Blood Loss ◽  
Risk Group ◽  
Placenta Previa ◽  
Massive Hemorrhage ◽  
High Risk Group ◽  
Massive Blood Loss ◽  
High Prevalence ◽  
Causes Of Deaths ◽  
Stage Analysis

Massive hemorrhage and hemorrhagic shock as main causes of deaths in pregnancy, occupy up to 25% in the structure of mortality rate in obstetrics. In the past decade, the decline in the share of deaths of mothers has occurred due to postpartum bleedings and bleedings in detachment or placenta previa. The aim of the study was to determine the frequency and structure of massive bleedings in a high-risk group obstetric hospital. Methods. A retrospective descriptive cohort study was executed in 2 stages: at the 1st stage - a study of 396 deliveries histories with main nosological forms leading to possible pathological hemorrhage, in the II stage - analysis of 55 cases of massive blood loss. The object of the study was puerperas with placenta previa; puerperas with deliveries complicated by hypotonic bleeding or premature detachment of the placenta; puerperas with the massive blood loss. Duration of the study: from 01.01.2011 to 31.12. 2015. Results. The most frequent nosological form leading to abnormal blood loss is premature placental abruption. The frequency of cases of massive blood loss (more than 1000 ml) is 0.28% of the total number of deliveries and is more common in primigravidae (56.4%), mainly during surgical delivery (88%). Out of all massive bleedings, 45.5% are due to uterine hypotension. Amputation of the uterus was performed in 18.2% of the number of all cases of the massive hemorrhage. Conclusion. The high prevalence rate of the premature detachment of the placenta is explained by the uncontrollability of this pathology, in contrast to hypotonic bleeding in the postpartum period. The organ-preserving management in massive obstetric hemorrhages is not widely used.

Infusion-transfusion therapy in the treatment of acute massive surgical blood loss in cancer surgery

2021 ◽  
Author(s):  
П.И. Феоктистов ◽  
А.Р. Шин ◽  
А.О. Приходченко ◽  
П.В. Вяткин ◽  
Е.Н. Феоктистова
Keyword(s):  
Blood Loss ◽  
Large Scale ◽  
High Efficiency ◽  
Malignant Tumors ◽  
Locally Advanced ◽  
Cancer Surgery ◽  
Quantitative Composition ◽  
Transfusion Therapy ◽  
Circulating Blood Volume ◽  
Somatic Status

Введение. Расширенные комбинированные вмешательства являются основным методом лечения пациентов с местнораспространенными солидными злокачественными опухолями. Основным следствием масштабной онкохирургии является риск развития острой массивной кровопотери (ОМОК). Цель исследования: оценка переносимости ОМОК у онкологических больных. Материалы и методы. В одноцентровое ретроспективное исследование с января 1999 г. по декабрь 2018 г. были включены 4236 больных, оперированных в радикальном объёме по поводу злокачественных опухолей различных локализаций, течение операции у которых осложнилось ОМОК. Критерием ОМОК являлась потеря ≥ 50% от расчётного объёма циркулирующей крови (ОЦКр) в течение 3 ч операции. Пациенты, вошедшие в исследование, были разделены на 4 группы в зависимости от объёма кровопотери: от 51 до 100%, от 101 до 200%, от 201 до 300% и свыше 300% ОЦКр. Результаты. Пациенты исследованных групп не различались ни по общим показателям, ни по исходному соматическому статусу. Про анализированы качественный и количественный состав инфузионно-трансфузионной терапии (ИТТ), показатели баланса жидкости интраоперационно, продолжительность пребывания пациентов в отделении реанимации и интенсивной терапии, летальность. Заключение. Соблюдение определенного протокола ИТТ при онкологических операциях, осложнённых ОМОК, является залогом успешного лечения и позволяет снизить интраоперационную летальность до 0,8% и госпитальную летальность до 6,45%. Метод аппаратной реинфузии аутоэритроцитов продемонстрировал высокую эффективность. Background. Cancer surgery remains the backbone of treatment approaches in patients with locally advanced solid malignancies. Risk of acute massive blood loss (AMBL) remains the main complication of such large-scale cancer surgery. Objectives: assessment of AMBL tolerance in cancer patients. Patients/Methods. A single- center retrospective study from January 1999 to December 2018 included 4,236 patients who underwent radical surgery for malignant tumors of various localizations, whose course of surgery was complicated with AMBL. The AMBL criterion was the loss of ≥ 50% of the calculated circulating blood volume (СBVс) within 3 hours of the operation. The patients included in the study were divided into 4 groups depending on the volume of blood loss: from 51 to 100%, from 101 to 200%, from 201 to 300% and over 300% of СBVс. Results. Patients of the studied groups did not differ either in general parameters or in baseline somatic status. The qualitative and quantitative composition of infusion-transfusion therapy (ITT), intraoperative fluid balance, patients stay in the intensive care unit, and mortality were analyzed. Conclusions. Compliance with a specific ITT protocol during cancer surgery complicated by AMBL is the key to successful treatment and allows to reduce intraoperative mortality to 0.8% and hospital mortality to 6.45%. The method of intraoperative red cell salvage and autologus transfusion has demonstrated high efficiency.

scholarly journals Coagulopathy in trauma

2014 ◽  
Vol 61 (4) ◽  
pp. 39-45
Author(s):  
Branislava Stefanovic ◽  
Branislav Stefanovic ◽  
Krstina Doklestic ◽  
Vesna Bumbasirevic ◽  
Aleksandar Karamarkovic ◽  
...  
Keyword(s):  
Blood Loss ◽  
Cause Of Death ◽  
Severe Trauma ◽  
Massive Hemorrhage ◽  
Coagulation System ◽  
Massive Blood Loss ◽  
Physiological Limits ◽  
New Knowledge ◽  
Special Challenge

Trauma is still a leading cause of morbidity and mortality in the contemporary community, particularly in population younger than 40 years of age. Recent studies have offered new knowledge on the central role of coagulopathy in traumatized people. Massive hemorrhage is a cause of death in severely traumatized people in 40% of cases, and the control of bleeding is a special challenge in the developed and verified coagulopathy. After severe trauma, massive hemorrhage is very often the consequence of associated surgical and coagulopathic bleeding. Massive blood loss diminishes the capacity of coagulation system, resulting in coagulopathy even in patients whose hemostasis before the injury has been within physiological limits.

Liver Hemostasis by Using Cold Plasma

2017 ◽  
Vol 24 (3) ◽  
pp. 253-258 ◽  
Author(s):  
Alexander Aleinik ◽  
Alexander Baikov ◽  
Georgiy Dambaev ◽  
Evgeniy Semichev ◽  
Pavel Bushlanov
Keyword(s):  
Blood Loss ◽  
Plasma Treatment ◽  
Bacterial Infections ◽  
Cold Plasma ◽  
High Efficiency ◽  
Nonequilibrium Plasma ◽  
Control Group ◽  
Surgical Interventions ◽  
Blood Indices ◽  
Group I

Surgical resection is associated with blood loss and bacterial infections. The aim of this study was to evaluate the effectiveness of cold plasma treatment during liver resection. Thirty adult male Wistar rats were divided randomly into 2 groups. Group I was the control group—intact animals (5 in total). The second group (25 in total)—experimental animals—had atypical resection of the left lobe of the liver with subsequent coagulation by “nonequilibrium” plasma. Histological tissue samples, biochemical blood indices, and hemocoagulation parameters were investigated on 3, 5, 7, 14, and 30 days after plasma treatment. The sterilization test was made to investigate the plasma bactericidal effects. Cessation of bleeding took less than 1 minute. Blood loss was negligible. Morphometric analysis of the liver revealed increased number of hepatocytes with signs of dystrophy after surgical intervention, which returned to the baseline values after 30 days. Biochemical blood parameters revealed significant differences in the groups only in terms of glucose ( P < .05); other parameters remained unchanged. High sterilization efficiency of cold plasma is confirmed. These results demonstrate the high efficiency of cold plasma treatment during surgical interventions.

Organizational aspects of acute massive blood loss therapy in pediatric surgical oncology

2020 ◽  
Vol 19 (3) ◽  
pp. 42-49
Author(s):  
N. P. Leonov ◽  
V. V. Shchukin ◽  
G. A. Novichkova ◽  
E. A. Spiridonova
Keyword(s):  
Blood Loss ◽  
Medical Center ◽  
Interdisciplinary Approach ◽  
Surgical Oncology ◽  
Surgical Removal ◽  
Joint Work ◽  
Circulating Blood Volume ◽  
Pediatric Hematology ◽  
Massive Blood Loss ◽  
National Medical

The organization of acute massive blood loss therapy in pediatric surgical requires an interdisciplinary approach in each medical center, depending on their profile. In our center, a protocol of acute massive blood loss therapy in pediatric surgical oncology has been developed and implemented. Systematic training of personnel and the development of team skills in the simulation class of the center became the basis for its implementation. In addition, the earlier initiation of therapy (with blood loss of more than 1 ml/kg/min) and actions aimed at reducing the time of critical hypotension became important conditions of the protocol. The acquired coagulopathy therapy and the prevention of massive transfusion syndrome are carried out only after the normalization of systemic hemodynamics. We present our experience of using this protocol in a 3-year-old child with acute massive blood loss more than 400% of the circulating blood volume during surgical removal of сhoriocarcinoma. The presented clinical case demonstrates not only the dramatic nature of the course of the disease, but also the good results of the organization and coordination of the joint work of all the center’s specialists. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. Parents gave their consent to use information about the child, including fotos, in the article.

Prevention of massive intraoperative bleedings associated with heparin with the systemic use of fibrin monomer in the experiment

2019 ◽  
pp. 48-55
Author(s):  
А.П. Момот ◽  
В.М. Вдовин ◽  
Д.А. Орехов ◽  
Н.А. Лычёва ◽  
И.Г. Толстокоров ◽  
...  
Keyword(s):  
Liver Injury ◽  
Blood Loss ◽  
Unfractionated Heparin ◽  
Loss Rate ◽  
Antithrombin Iii ◽  
Fibrinogen Level ◽  
Circulating Blood Volume ◽  
Intraoperative Bleeding ◽  
Fibrin Monomer ◽  
Antithrombin Iii Activity

Цель исследования - изучение способности фибрин-мономера предупреждать тяжелую интраоперационную кровопотерю, ассоциированную с введением нефракционированного гепарина, при дозированной травме печени. Методика. На кроликах «Шиншилла» индуцировали гипокоагуляцию нефракционированным гепарином (150 ед/кг). Профилактику интраоперационных кровотечений осуществляли внутривенным введением фибрин-мономера (0,25 мг/кг) за 1 ч до травмы или протамина сульфата (1,5 мг/кг) за 10 мин до травмы. После нанесения стандартной травмы печени оценивали объем (в % ОЦК) и темп (мг/с) кровопотери. Анализировали число тромбоцитов, активированное парциальное тромбопластиновое время, протромбиновое и тромбиновое время свертывания, уровень фибриногена и активность антитромбина III, параметры ротационной тромбоэластометрии крови. Результаты. Объем кровопотери в группах животных после в/в введения фибрин-мономера и протамина сульфата на фоне гепаринизации был, соответственно, в 5,1 и 4,0 раза меньше по сравнению с группой плацебо, получавшей тот же антикоагулянт. Вместе с тем, фибрин-мономер не влиял на параметры коагулограммы (отсутствие видимого гемостазиологического эффекта) и тромбоэластограммы, тогда как применение протамина сульфата в качестве антидота гепарина сопровождалось нормализацией данных тромбоэластометрии и коррекцией гипокоагуляционного сдвига по активированному парциальному тромбопластиновому времени, протромбиновому и тромбиновому времени. Заключение. Установлено, что фибрин-мономер (0,25 мг/кг) снижает посттравматическое кровотечение в условиях блокады свертывания крови гепарином без видимых признаков восстановления гемостатического равновесия. The research objective was to study the ability of fibrin monomer to prevent severe intraoperative blood loss associated with administration of unfractionated heparin in controlled liver injury. Methods. Hypocoagulation was induced in chinchilla rabbits with unfractionated heparin (150 U/kg). Intraoperative bleeding was prevented by administration of fibrin monomer (FM, 0.25 mg/kg, i.v.) one hour prior to the injury and of protamine sulfate (PS, 1.5 mg/kg, i.v.) 10 min prior to the injury. Following the liver injury, blood loss was assessed as percentage of circulating blood volume and the blood loss rate (mg/s). Platelet counts, aPTT, PT, TT, fibrinogen level, antithrombin III activity, and parameters of blood rotation thromboelastometry were analyzed. Results. The volume of blood loss was 5.1 times and 4.0 times less, respectively, after the FM and PS administration during heparinization compared to the placebo group treated with the same anticoagulant. However, FM affected neither coagulogram indexes (no visible hemostasiological effect) nor thromboelastogram while the use of PS as an antidote for heparin was associated with normalization of thromboelastometric data and correction of hypercoagulative changes in aPTT, PT, TT. Conclusion. FM at a dose of 0.25 mg/kg reduced severity of posttraumatic bleeding induced by heparin inhibition of coagulation with no visible signs of hemostatic balance recovery.

scholarly journals Experimental Methods to Simulate and Evaluate Postsurgical Peripheral Nerve Scarring

2021 ◽  
Vol 10 (8) ◽  
pp. 1613
Author(s):  
Alessandro Crosio ◽  
Giulia Ronchi ◽  
Benedetta Elena Fornasari ◽  
Simonetta Odella ◽  
Stefania Raimondo ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Peripheral Nerves ◽  
Experimental Methods ◽  
Scar Tissue ◽  
Experimental Models ◽  
Tissue Formation ◽  
Surgical Interventions ◽  
Pubmed Database ◽  
Different Types ◽  
Scar Tissue Formation

As a consequence of trauma or surgical interventions on peripheral nerves, scar tissue can form, interfering with the capacity of the nerve to regenerate properly. Scar tissue may also lead to traction neuropathies, with functional dysfunction and pain for the patient. The search for effective antiadhesion products to prevent scar tissue formation has, therefore, become an important clinical challenge. In this review, we perform extensive research on the PubMed database, retrieving experimental papers on the prevention of peripheral nerve scarring. Different parameters have been considered and discussed, including the animal and nerve models used and the experimental methods employed to simulate and evaluate scar formation. An overview of the different types of antiadhesion devices and strategies investigated in experimental models is also provided. To successfully evaluate the efficacy of new antiscarring agents, it is necessary to have reliable animal models mimicking the complications of peripheral nerve scarring and also standard and quantitative parameters to evaluate perineural scars. So far, there are no standardized methods used in experimental research, and it is, therefore, difficult to compare the results of the different antiadhesion devices.

Predictors of massive blood loss from placenta accreta: Wright et al

2011 ◽  
Vol 205 (1) ◽  
pp. 85-86
Author(s):  
Anthony Shanks ◽  
Jennifer McNamara ◽  
Meiling Hua ◽  
Jessica McPherson
Keyword(s):  
Blood Loss ◽  
Placenta Accreta ◽  
Massive Blood Loss

Systemic hemostatic and hemostasiological effects of fibrin monomer in low dose under warfarin action in experiment

2019 ◽  
Author(s):  
В.М. Вдовин ◽  
А.П. Момот ◽  
Д.А. Орехов ◽  
И.Г. Толстокоров ◽  
В.О. Шевченко ◽  
...  
Keyword(s):  
Liver Injury ◽  
Blood Loss ◽  
Prothrombin Complex Concentrate ◽  
Coagulation Factors ◽  
International Normalized Ratio ◽  
Blood Coagulation Factors ◽  
Circulating Blood Volume ◽  
Hemostatic Effect ◽  
Blood Loss Volume

Введение. Ранее было показано, что фибринмономер (ФМ) в низких дозировках обладает системным гемостатическим действием в условиях дозированной травмы. Авторами выдвинута гипотеза, согласно которой ФМ способен оказывать регулирующее гемостатическое действие in vivo на фоне сниженного гемостатического потенциала. Цель исследования: изучение системных гемостатических и гемостазиологических эффектов ФМ на фоне дозированной травмы печени при гипокоагуляции, обусловленной приемом варфарина. Материалы и методы. В работе использовали 40 кроликов породы Шиншилла. Для индукции кумаринобусловленной гипокоагуляции животным per os вводили варфарин в дозе 0,4 0,5 мг/кг 14 дней до достижения международного нормализованного отношения (МНО) более 2,0. Далее животным в краевую вену уха вводили концентрат факторов протромбино вого комплекса (КФПК) в дозе 40 ЕД/кг, ФМ в дозе 0,25 мг/кг или плацебо. Через 1 ч после введения препаратов наносили травму печени и оценивали кровопотерю (в процентах от объема циркулирующей крови). Исследовали число тромбоцитов, активированное парциальное тромбопластиновое время, МНО, содержание фибриногена и Ддимера, оценивали результаты тромбоэластографии крови. Результаты. Объем кровопотери в группах животных после внутривенного введения ФМ и КФПК на фоне приема варфарина был в 9,1 раза и 6,7 раза меньше, соответственно, по сравнению с группой плацебо, получавшей тот же антикоагулянт. Вместе с тем ФМ не влиял на параметры коагулограммы (отсутствие видимого гемостазиологического эффекта) и тромбоэластограммы, тогда как применение КФПК в качестве антидота варфарина сопровождалось нормализацией параметров тромбоэластометрии и коррекцией гипокоагуляционного сдвига по МНО. Заключение. Установлено, что ФМ способен проявлять свое системное гемостатическое действие в условиях сниженного тромбинообразования, обусловленного нарушением синтеза витамин Кзависимых факторов свертывания крови. Данное действие реализуется без признаков восстановления гемостатического равновесия. Introduction. It was shown earlier that fibrinmonomer (FM) in low doses had a systemic hemostatic effect in a controlled injury condition. The authors suggest that FM is able to exert a regulating hemostatic effect in vivo under reduced hemostatic potential. Aim: to study the systemic hemostatic and hemostasiological effects of FM under controlled liver injury during hypocoagulation caused by warfarin administration. Materials and methods. In this study 40 Chinchilla rabbits were used. For the induction of coumarinmediated hypocoagulation, animals were administered per os warfarin at a dose of 0.4 0.5 mg/kg for 14 days, until an international normalized ratio (INR) was more than 2.0. Subsequently, a prothrombin complex concentrate (PCC) at a dose of 40 U/kg, FM at a dose of 0.25 mg/kg or placebo were administered into the marginal ear vein of the animals. An hour later, a liver injury was inflicted and blood loss was assessed (in percents of the circulating blood volume). The number of platelets, activated partial thromboplastin time, INR, levels of fibrinogen and Ddimer were studied and the results of blood thromboelastography were evaluated. Results. Blood loss volume in animals groups after intravenous administration of FM and PPC, under warfarin reception, was 9.1 times and 6.7 times less, respectively, compared to the placebo group receiving the same anticoagulant. However, FM did not affect on coagulogram parameters (no visible hemostasiological effect) and thromboelastogram, whereas the use of PPC as warfarin antidote was accompanied by the normalization of thromboelastometry parameters and hypocoagulation shift correction according to INR. Conclusion. It was found that FM able to manifest its systemic hemostatic effect in conditions of reduced thrombin formation caused by impaired synthesis of vitamin Kdependent blood coagulation factors. This effect is implemented without any signs of recovery of hemostatic balance.

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