Patient Blood Management: Single Center Evidence and Practice at Fuwai Hospital.

Blood loss and blood transfusion requirement are important quality control indicators of cardiovascular surgery and cardiovascular anesthesia. Patient blood management (PBM) is an evidence-based, multidisciplinary approach to optimizing the care of patients who may need transfusion, which encompasses anemia management, hemodilution, cell salvage, hemostatic treatment, and other approaches to reducing bleeding and minimizing blood transfusion. PBM in cardiovascular surgery is a "team sport" that involves cardiac and vascular surgeons, anesthesiologists, perfusionist, intensivists, and other health care providers. The current work provides an overview of evidence and practice of PBM at Fuwai Hospital. Implementation of PBM should also take local resource availability and cost-effectiveness of different devices, drugs, technologies, and techniques into consideration.

[Establishment of normal reference values for thromboelastography on Chinese population in Beijing].

OBJECTIVE: To determine the normal values for thromboelastography (TEG) in Chinese healthy adult volunteers residing in Beijing for over three years and compare them with those of the manufacturer's. METHODS: A total of 137 healthy adult volunteers were enrolled from June 2010 to August 2010. The technique was standardized with citrated blood and kaolin activator. And a Haemoscope 5000 device was employed. The TEG parameters analyzed were R, K, α, maximal amplitude (MA), LY30 and coagulation index (CI). All volunteers underwent the tests of prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and plasma fibrinogen level with the same blood sample. RESULTS: The reference ranges of 95% for 137 volunteers were R: 3.8 - 8.4 min, K: 0.8 - 3.3 min, α-Angle: 46.2 - 76.2°, MA: 50.0 - 70.8 mm, LY30: -3.3% - 4.0% and CI: -3.8 - 2.9. Overall, 24.1% (33/137) of the volunteers had at least one abnormal parameter while 7.3% (10/137) would have been considered coagulopathy had the manufacturer's reference values been used, resulting in a test specificity of 76.0%. As compared with the western ethnicity (the manufacturer's reference values), Chinese healthy volunteers were associated with lower fibrinogen functions. There were significantly different in R, K, α-Angle, MA and CI between men and women groups (all P < 0.01). CONCLUSION: This study supports the manufacturer's recommendation that each institute should determine its own normal reference values.