Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Preoperative Clinical and Laboratory Assessment of the Patient

Abstract The preoperative clinical and laboratory evaluations of the patient is an essential step to ensure the safety and success of any surgical procedure. This assessment aims to identify any underlying medical conditions and risk factors and determine suitability for surgery. With this step, the medical team can adapt the care plan to meet each patient's specific needs, increasing the chances of a successful procedure. Good clinical assessment and comprehensive laboratory testing, when integrated into a Patient Blood Management approach, are invaluable in promoting safety of care, reducing transfusion risks, improving surgical outcomes, and optimizing resource utilization. This approach not only elevates the quality of care, but is also aligned with evidence-based practice and patient-centered principles, making it an essential component of the perioperative process.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Assessment and management of coagulation in the preoperative period

Abstract Managing coagulation disorders and potential bleeding risks, especially in the context of anticoagulant medications, is of immense value both clinically and prior to surgery. Coagulation disorders can lead to bleeding complications, affecting patient safety and surgical outcomes. The use of Patient Blood Management protocols offers a comprehensive, evidence-based approach that effectively addresses these challenges. The problem is to find a delicate balance between preventing thromboembolic events (blood clots) and reducing the risk of bleeding. Anticoagulant medications, although crucial to preventing clot formation, can increase the potential for bleeding during surgical procedures. Patient blood management protocols aim to optimize patient outcomes by minimizing blood loss and unnecessary transfusions.

Blood conservation strategy in infants undergoing cardiopulmonary bypass during the open heart surgery / 天津医药

In the cardiovascular surgery of infants,especially in complex congenital heart surgery,the advantages and disadvantages of blood supply and demand have gradually attracted clinical attention.Besides,allogeneic blood transfusion may lead to the infection of infectious diseases. As a result, how to minimize postoperative bleeding, reduce the usage of allogeneic blood products,and avoid the damage of blood has become a hot issue for urgent consideration and solution.The blood coagulation system of infants is not mature compared with adults, and the operation of congenital heart disease is becoming more and more complex, which makes the issue of maintaining the blood coagulation system of infants become increasingly prominent.This paper provides a reference for perfecting blood conservation strategy of infants with congenital heart disease, which systematically reviews the application progress of minimized extracorporeal circulation circuits, combined ultrafiltration technology,vacuum assist venous drainage,blood dilution and priming,utilization of antifibrinolytic drugs,and application of autotransfusion.

Comparison of Effects of Pressure Controlled Ventilation and Volume Controlled Ventilation on Perioperative Blood Loss of Patients with Posterior Lumbar Interbody Fusion / 医学研究杂志

Objective To compare the effects of pressure controlled ventilation and volume controlled ventilation on perioperative blood loss of patients with posterior lumbar interbody fusion (PLIF).Methods According to the random number table method,a total of 88 patients scheduled to PLIF were allocated into two groups,44 cases per groups.Patients received respectively pressure controlled ventilation and volume controlled ventilation in pressure controlled ventilation group (PCV group) and volume controlled ventilation group (VCV group).Mean arterial blood pressure (MAP),heart rate (HR) and central venous pressure (CVP) were continuously monitored at anesthesia induction immediately (T0),10min after supine position to prone position (T1),skin suture immediately (T2),10min after prone position to supine position (T3) and when tracheal extubation (T4).Hemoglobin (Hb) and hematokrit (HCT) were tested from T0 to T4 in the two groups.Respiratory parameters were recorded from T0 to T3 in the two groups.Intraoperative blood loss and blood loss at 96h after operation patients were recorded.Allogeneic blood transfusion,volume of fluid input and the rate of secondary surgery to stop th bleeding were recorded in the two groups.Results Compared to VCV group,peak inspimtory pressure (PIP) from T1 to T3 were all significantly lower (P ＜0.05) in PCV group.There was no statistical significance (P ＞ 0.05) in MAP,HR,tidal volume,respiratory rate (RR),PaO2/FiO2 and PaCO2 between the two groups.There was no statistical significance (P ＞ 0.05) in Hb and Hct at different time points between the two groups.Compared to VCV group,intraoperative blood loss,plasma infusions and red blood cell infusions were al significantly lower (P ＜ 0.05) in PCV group.Conclusion PCV can decrease intraoperative blood loss of patients with PLIF,which may be related to lower PIP during operation.

Pilares del ahorro transfusional / Pillars in the blood conservation

Las transfusiones sanguíneas alogénicas han tenido un rol central en el desarrollo de la medicina, principalmente como terapia de soporte en pacientes críticos, cirugía mayor, trauma y trastornos hematopoyéticos. Sin embargo, su utilización no está exenta de importantes efectos adversos y de altos costos asociados. Además, los productos sanguíneos son un recurso limitado que no debe ser desperdiciado. Por otro lado, la cirugía en pacientes que rehúsan la utilización de hemoderivados ha mostrado igual o mejores resultados que los pacientes que aceptan transfusiones. Esto ha llevado a buscar un manejo apropiado de la sangre en todos nuestros pacientes, evitando los riesgos y costos innecesarios de las transfusiones, pero permitiéndolos cuando se cree que los beneficios serán mayores que los riesgos. En este trabajo se presentan 3 pilares esenciales. El primero es el diagnóstico y manejo apropiado de la anemia preoperatoria, disminuyendo los riesgos perioperatorios, ya que la anemia por sí sola es un factor de morbimortalidad. El segundo pilar está constituido por diversas técnicas, que están disponibles en la actualidad, para minimizar el sangrado perioperatorio. Finalmente, el tercer pilar es mejorar la tolerancia a la anemia. El uso en conjunto de diversas técnicas descritas en este trabajo ha mostrado ser efectivo en disminuir el sangrado perioperatorio, la necesidad de transfusiones alogénicas y las unidades de sangre utilizadas, lo cual podría permitir mejores resultados clínicos en nuestros pacientes.

Allogeneic blood transfusions have played a central role in the development of medicine, mainly as a support therapy in critically ill patients, major surgery, trauma and hematopoietic disorders. However, their use is not without significant adverse effects and associated high costs. Moreover, blood products are a limited resource that should not be wasted. Furthermore, surgery in patients who refuse the use of blood products has shown equal or better results than patients who accept transfusions. This has led to seek an appropriate blood management in all our patients, avoiding unnecessary costs and risks of transfusions, but allowing them when they believe the benefits outweigh the risks. In this paper three essential pillars are presented. The first is the appropriate diagnosis and management of pre-operative anaemia decreasing perioperative risk, since anaemia itself is a factor of morbidity and mortality. The second pillar is formed by various techniques that are available today to minimize bleeding perioperative. Finally, the third pillar is to improve tolerance to anaemia. The joint use of various techniques described in this paper has proven effective in decreasing perioperative bleeding, the need for allogeneic transfusions and blood units used, which may allow better clinical outcomes in our patients.

The effects of controlled hypotension combined with tranexamic acid on peri-operative blood loss and ;coagulation function in patients undergoing brain tumor surgery / 实用医学杂志

Objective To investigate the effects of controlled hypotension (CH) combined with tranexamic acid (TA) on peri-operative blood loss and coagulation function in patients undergoing brain tumor surgery. Methods Forty patients undergoing brain tumor surgery were randomly allocated into group A and group B with 20 patients in each group. Patients in group A received CH alone, while patients in group B received CH combined with TA. Coagulation factors and d-dimer levels were measured 24 hours before and after surgery. Amount of blood loss, intravenous fluid transfused, urine output and postoperative drainage were recorded. Results D-dimer levels of 24 hours after surgery increased compared with that of 24 hours before surgery. In group B, the d-dimer level increased more than that of group A (P < 0.05). No significant difference was found in coagulation factor levels between group A and group B. Amount of blood loss, intravenous fluid transfused and postoperative drainage flows of patients in group B were lower than that in group A (P < 0.05). There were no significant changes in urine output and fluid infusion volume between two groups. Conclusion CH compared with TA can reduce perioperative blood loss in patients undergoing brain tumor surgery , with no obvious coagulant function abnormality. Collectively, it should be a safe and reliable method for clinical application.

Knowledge, Attitude and Practice of Blood Conservation Strategies amongst Physicians’ in Tertiary Hospitals.

Aim: To assess the extent of available knowledge, as well as the attitudes and the utilization of blood conservation strategies amongst medical doctors, who are the implementers of blood transfusion and conservation in clinical practice. Study Design: A cross-sectional study. Place and Duration of Study: Clinical Departments in both Lagos State University Teaching Hospital, Lagos State and Babcock University Teaching Hospital, Ogun State between August 2013 and November 2013. Methodology: We included clinicians from various medical specialties in the study (78 from public hospital and 26 from private hospital). A pre-tested, self-administered questionnaire was devised to collect data. Data was entered and analyzed descriptively and qualitatively. Result: A total of 104 doctors participated in the study consisting of 57 males (54.80%) and 47 females (45.29%). Almost all participants had transfused blood in their practice and all participants were aware that blood transfusions have complications. Majority 80 (76.9%) had heard about blood conservation techniques, about 51 (49%) had used any of the strategies. If available, 93 (89.4%) would use any of the strategies, only 1 (1%) would not. Conclusion: There is a need for hospital transfusion committees to educate and increase the drive for utilization of blood conservation methods amongst doctors, so as to increase its practice.

Anesthesia for a jehovah’s witness with critical anemia from ruptured stomach GIST.

We report a case of a female Jehovah’s Witness admitted to the hospital with concealed rupture of stomach gastrointestinal stromal tumor (GIST) and scheduled for exploratory laparotomy with tumor removal. She was critically anemic and refused to receive all kinds of blood or blood products. We present anesthesia techniques to avoid blood transfusion in this patient, which include deliberate hypotension and acute normovolemic hemodilution.

Application of hemodilution combined with tranexamic acid in neurosurgical operation / 中国医师进修杂志

ObjectiveTo study the safety and effectiveness of acute hypervolemic hemodilution (AHH) combined with tranexamic acid(TA) in neurosurgical operation. Methods Forty patients underwent selective neurosurgical operation were divided into two groups by radom digits table with 20 cases each, both groups were infused HES(130/0.4) 20 ml/kg for AHH after anesthesia, TA intravenous injection of loading 10 mg/kg, 1 mg/(kg·h) continuous infusion until the end of surgery in experimental group,only for AHH in control group. The mean arterial blood pressure(MAP), central venous pressure(CVP), heart rate (HR), pulse oxygen saturation (SpO2) were measured before AHH (T0), A HH immediately (T1), 1 h after AHH (T2), at the end of operation (T3), and in the corresponding time hemoglobin (Hb), hematocrit (Hct),prothrombin time (PT), activated partial thromboplastin time (APTT), platelet ( Plt ), fibrinogen ( FIB ) were measured; the intraoperative bleeding, blood transfusion and transfusion rate were counted in both groups.ResultsThere was no significant difference in HR and MAP at different time between two groups (P ＞0.05),compaued with T0,CVP at T1,T2 was increased (P＜0.05),Hb and Hct at T1,T2,T3 were decreased (P＜ 0.05 ). PT and APTT at T2,T3 were longer than that at T0 in control group (P＜ 0.05 ) ;Plt at T1 ,T2,T3 was lower in control group than that at T0 in two groups (P ＜ 0.05 ), Plt at T2, T3 was obviously increased in control group compared with experimental group (P ＜ 0.01 ) ; FIB at T2, T3 was lower than that at T0 in control group (P ＜0.05). The intraoperative bleeding, blood transfusion and transfusion rate in experimental group [(650 ±560) nl, (150 ± 50)ml,30％(6/20)]were lower than those in control group [(820 ±410) ml,(380 ±290) ml,60％ (12/20)],there were significant differences between two groups(P ＜0.05).ConclusionAHH combined with TA has obvious effect of saving blood and hemodynamic stability with less influence on coagulation in neurosurgical operation.

Parâmetros bioquímicos e hemogasométricos do sangue total canino armazenado em bolsas plásticas contendo CPDA-1 e CPD/SAG-M / Parameter biochemical and hemogasometric of the total blood stored of dogs in plastic stock markets I contend CPDA-1 and CPD/SAG-M

O presente trabalho teve como objetivo avaliar e comparar as alterações bioquímicas e hemogasométricas do sangue total canino armazenado em bolsas CPDA-1 e CPD/SAG-M. Foram utilizados 14 cães machos, adultos e saudáveis, distribuídos em dois grupos com sete animais cada, dos quais foi obtido sangue para o estudo. No primeiro grupo (G1), o sangue foi armazenado em bolsas CPDA-1 e, no segundo grupo (G2), o sangue foi armazenado em bolsas CPD/SAG-M. As amostras foram analisadas para: potássio, sódio, glicose, proteína plasmática total, DPG, pH sangüíneo, pO2 , pCO2 e bicarbonato. Os momentos estabelecidos para as análises laboratoriais foram: D0: imediatamente após a coleta do sangue dos animais; D7: sete dias após a coleta; D14: quatorze dias após a coleta; D21: vinte e um dias após a coleta; D31: trinta e um dias após a coleta; D41: quarenta e um dias após coleta. A análise dos resultados permitiu concluir que a bolsa CPD/SAG-M apresentou melhor desempenho quando comparada à CPDA-1 após 41 dias de estocagem. O DPG, mesmo com pH inferior a sete, continua sendo produzido por, pelo menos, uma semana após a estocagem do sangue na bolsa.

The present study was aimed at evaluating and comparing the biochemical and haemogasometrics alterations of the total blood of dogs stored in bags CPDA-1 and CPD/SAG-M. 14 male's dogs, adult and healthful dogs, were divided in two groups, which one blood was removed for the study. The blood of the first group (G1) was stored in bag CPDA-1 and that of the second group (G2) in bag CPD/SAG-M. The samples were analyzed for: potassium, sodium, glucose, total plasmatic protein, DPG, pH, pO2 , pCO2 , and bicarbonate. The moments for the laboratory analyses were established: D0: immediately after the collection of blood; D7: seven days after the collection; D14: fourteen days after the collection; D21: twenty and one days after the collection; D31: thirty and one days after the collection; D41: forty one days after collect. The evaluation of the results allowed including that: the bag CPD/SAG-M presented advantage when compared with the CPDA-1 after 41 days of stored. The DPG, even with pH lower then 7, continues being produced for, at least, one week after the stocking of the blood in the bag.

Strategy to reduce allogeneic transfusion in the perioperative periods of open heart surgical procedures / 中国输血杂志

Objective To provide a strategy for open heart surgical procedures of reducing allogeneic transfusion in the perioperative periods.Methods A comprehensive blood conservation program and new transfusion criteria[haemoglobin(Hb)were0.05).The Hct was down after operation in both groups.In the test group the Hct decreased in to 30% at day7 postoperation and regained gradually after 14 days of operation.Conclusion The dininishing allogeneic transfusion can be achieved by application of comprehensive blood conservation techniques and new transfusion criterion during the perioperative periods of open heart surgical procedures.The operative curative effect is not influence thereby.

Postoperative autotransfusion using a blood drainage and transfusion device, ConstaVac, in patients with total knee replacement / 대한마취과학회지

ConstaVac (Stryker, Michigan, U.S.A.), a blood drainage and transfusion device, was applied to transfuse the autologous blood from the wound in 20 patients undergoing total replacement under the spinal anesthesia To evaluate the hemodynamic states, direct arterial blood pressures and central venaus pressures were monitored. Before touniquets release, 500-1000 ml of 10% pentastarch were infused rapidly to prevent hypovolemia until the driining reservior bag was filled to at least 40 ml. During all the procedures the mean arterial pressures were main-tained at about 80 mmHg, even if tbose after the induction of anesthesia were lower tban those at the preanesthetic period. The average amounts of blood loss were 942 ml and 2240 ml in unilateral and simultaneous bilateral surgery, respectively. The average amounts of blood that were salvaged after unilateral and simultaneous bilateral knee arthroplasty were 1113 and 2918 ml, respectively. Until 7 posto-perative days, thrombocytopenia and anemia were developed in one and three cases, respectively. We concluded that the use of the ConstaVac in the immediate postoperative period is a useful and practical method of autologous transfusion and conservation of a previous resource, and we recommend its use especially in simultaneous bilateral knee arthroplasty.

The effects of plateletpheresis on blood conservation during cardiopulmonary bypass / 中国输血杂志

Objective To investigate the effects of plateletpheresis on blood conservation following cardiopulmonary bypass.Methods 20 patients undergoing open heart surgery were divided randomly into experiment and control groups.All patients underwent routine CPB.Plateletpheresis was performed in experiment group by using COBE SPECTRA.Other blood conservation approaches were similar in two groups.Results The number of platelets collected in experiment group exceeded 20% of total platelets of every patients.In the experiment group,less transfusion was need.The changes of Hb and Hct at every time point were similar in the two groups.Platelet counts,aggregation,and prothrombin time in the experiment group restored to preoperative levels significantly earlier than in the control group.The chest tube drainage at 2,4,8,and 16 h and the total drainage after operation were significantly lower in the experiment group than those in the control group.Conclusion By protecting platelets from destruction by extracorporeal circulation,plateletpheresis is beneficial to the recovery of haemostatic system.It is a useful blood conservation method.