Hematologic evaluation of intraoperative autologous blood collection and allogeneic transfusion in cardiac surgery

Transfusion ◽  
2021 ◽  
Author(s):  
Reney A. Henderson ◽  
Miranda Judd ◽  
Erik R. Strauss ◽  
James S. Gammie ◽  
Michael A. Mazzeffi ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Autologous Blood ◽  
Blood Collection ◽  
Allogeneic Transfusion

Comparison of Blood-conservation Strategies in Cardiac Surgery Patients at High Risk for Bleeding

2000 ◽  
Vol 92 (3) ◽  
pp. 674-682 ◽  
Author(s):  
Gregory A. Nuttall ◽  
William C. Oliver ◽  
Mark H. Ereth ◽  
Paula J. Santrach ◽  
Sandra C. Bryant ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Cardiopulmonary Bypass ◽  
Tranexamic Acid ◽  
Combined Therapy ◽  
Autologous Blood ◽  
Blood Collection ◽  
Transfusion Requirements ◽  
Risk For Bleeding

Background Aprotinin and tranexamic acid are routinely used to reduce bleeding in cardiac surgery. There is a large difference in agent price and perhaps in efficacy. Methods In a prospective, randomized, partially blinded study, 168 cardiac surgery patients at high risk for bleeding received either a full-dose aprotinin infusion, tranexamic acid (10-mg/kg load, 1-mg x kg(-1) x h(-1) infusion), tranexamic acid with pre-cardiopulmonary bypass autologous whole-blood collection (12.5% blood volume) and reinfusion after cardiopulmonary bypass (combined therapy), or saline infusion (placebo group). Results There were complete data in 160 patients. The aprotinin (n = 40) and combined therapy (n = 32) groups (data are median [range]) had similar reductions in blood loss in the first 4 h in the intensive care unit (225 [40-761] and 163 [25-760] ml, respectively; P = 0.014), erythrocyte transfusion requirements in the first 24 h in the intensive care unit (0 [0-3] and 0 [0-3] U, respectively; P = 0.004), and durations of time from end of cardiopulmonary bypass to discharge from the operating room (92 [57-215] and 94 [37, 186] min, respectively; P = 0.01) compared with the placebo group (n = 43). Ten patients in the combined therapy group (30.3%) required transfusion of the autologous blood during cardiopulmonary bypass for anemia. Conclusions The combination therapy of tranexamic acid and intraoperative autologous blood collection provided similar reduction in blood loss and transfusion requirements as aprotinin. Cost analyses revealed that combined therapy and tranexamic acid therapy were the least costly therapies.

A guideline nomogram to control intraoperative haemodilution in cardiac surgery

Perfusion ◽  
1994 ◽  
Vol 9 (1) ◽  
pp. 65-69 ◽  
Author(s):  
M. Ranucci ◽  
D. Conti
Keyword(s):  
Cardiac Surgery ◽  
Statistical Analysis ◽  
Cardiopulmonary Bypass ◽  
Autologous Blood ◽  
Adult Patients ◽  
Fluid Replacement ◽  
Blood Collection ◽  
Common Procedure ◽  
Theoretical Assumptions ◽  
Set Up

Intraoperative blood collection prior to cardiopulmonary bypass (CPB) is a common procedure in cardiac surgery. Its aims are to obtain fresh whole blood to be infused after CPB, to use autologous blood in the prime or to avoid too high levels of haematocrit (HCT) during CPB. Calculations to determine the amount of blood to be collected are generally based on theoretical assumptions. In this paper we have set up and controlled, on a clinical basis, a nomogram to be used in order to obtain a standard pre-CPB HCT equal to 38%, using a moderately hypervolaemic haemodilution based on blood collection simultaneous with fluid replacement. Thirty adult patients were evaluated in order to settle the nomogram; subsequently, the nomogram validity was checked on 100 adult patients. Statistical analysis revealed the good clinical usefulness of this instrument.

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.

Pathophysiological aspects of cardiotomy suction usage

Perfusion ◽  
2010 ◽  
Vol 25 (3) ◽  
pp. 147-152 ◽  
Author(s):  
Vladimir Svitek ◽  
Vladimir Lonsky ◽  
Faraz Anjum
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Transfusion Requirement ◽  
Artery Bypass ◽  
Autologous Blood ◽  
The Other ◽  
Coronary Artery Surgery ◽  
Cardiotomy Suction

Cardiotomy suction is used for preservation of autologous blood during on-pump cardiac surgery at present. Controversially, the exclusion of cardiotomy suction in some types of operations (coronary artery bypass surgery) is not necessarily associated with an increased transfusion requirement. On the other hand, the use of cardiotomy suction causes an amplification of systemic inflammatory response and a resulting coagulopathy, as well as exacerbation of the microembolic load and hemolysis. This leads to a tendency towards increased blood loss, transfusion requirement and organ dysfunction. On the basis of these facts, it is appropriate to reconsider routine use of cardiotomy suction in on-pump coronary artery surgery.

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