Intraoperative Bleeding Management: An Updating Literature Review: Review Article

Background: Intraoperative bleeding remains a major complication during and after surgery, leading to increased morbidity and mortality. Several influences determine the complex causes of bleeding in surgical patients. About 75 to 90% of early intraoperative and postoperative bleeding is due to technical factors. In some cases, however, acquired or congenital coagulopathies can stimulate, if not directly cause, surgical bleeding. Objectives: This paper aims to overview etiology, causes, diagnosis, and updated management of intraoperative bleeding. Methods: The review article ran from July 1, 2021 to October 31, 2021. We searched articles on etiology, causes, and treatments published in English worldwide in the Medline, EBSCO and PubMed databases. No software was used to analyze the data. Team members reviewed the data to determine initial results. Results: All patients scheduled for elective surgery should be screened for possible hemostatic defects using tests, and, if necessary, laboratory tests. Treatment of intraoperative bleeding consists of identifying patients at risk and understanding the effect of surgery on hemostasis. For patients at high risk of bleeding, a pre-operative meeting with a multidisciplinary team (anesthesiologist, surgeon, hematologist, radiologist) can discuss the correct surgical procedure. Conclusion: Technical variables account for 75-90% of initial intraoperative and postoperative bleeding. However, in other cases it is associated with acquired or congenital coagulation disorders. All patients scheduled for elective surgery should be checked for problems with hemostasis. Treatment of intraoperative bleeding involves identifying those at risk and understanding the effect of surgery on hemostasis.

Extensive thrombosis after COVID-19 vaccine: cause or coincidence?

A 62-year-old Caucasian female patient presented with abdominal pain, vomiting and fever 1 day after administration of COVID-19 vaccine. Bloodwork revealed anaemia and thrombocytosis. Abdominal CT angiography showed a mural thrombus at the emergence of the coeliac trunk, hepatic and splenic arteries, and extensive thrombosis of the superior and inferior mesenteric veins, splenic and portal veins, and the inferior vena cava, extending to the left common iliac vein. The spleen displayed extensive areas of infarction. Aetiological investigation included assessment of congenital coagulation disorders and acquired causes with no relevant findings. Administration of COVID-19 vaccine was considered a possible cause of the extensive multifocal thrombosis. After reviewing relevant literature, it was considered that other causes of this event should be further investigated. Thrombosis associated with COVID-19 vaccine is rare and an aetiological relationship should only be considered in the appropriate context and after investigation of other, more frequent, causes.

Rola leczenia żywieniowego dzieci z wrodzonymi skazami krwotocznymi

Balancing diet in patients with congenital haemorrhagic diatheses is very important because of the need to eliminate excess weight and at the same time strengthen muscle mass. This has an important role in the treatment and prevention of strokes. The food provided to these children should secure the right amount of energy nutrients and fluids in the right proportions. After investigating the cause and complications associated with the course of the disease, we can reduce symptoms. An individual approach to each patient and the choice of a right diet will reduce the duration of treatment, ensure better development and growth, as well as improving quality of life. Additionally, it is necessary to assess the level of physical activity of each patient and, when it is too low, recommend them to increase it. Proper rehabilitation, which mainly concerns patients with congenital plasma diatoma, is especially important. Another symptom, occurring mainly in girls, is profuse menstruation and associated iron deficiency anemia. In this article we present the most important nutritional problems which a physician dealing with patients (both boys and girls) with congenital coagulation disorders should manage.