Peroperative Assessment of Bleeding For Clotting Factors By Visual Observation in Liver Resections And Other HPB Surgeries

Abstract

Introduction: During surgery of a cirrhotic liver and liver transplant in recipient patients lots of bleeding occurs and sometimes it is life threatening. There are chances of patients to go under the disseminated intravascular coagulation. Normally we have to send the specimen of blood frequently for the determination of coagulation factor. We can also avoid this frequent laboratory check if we see that blood is being clotted in the peritoneal cavity. If it is being clotted then it means there are sufficient clotting factors. If the blood is very thin and not being clotted then it means that patient needs clotting factors or fresh frozen plasma. Method: We operated 40 patients of Hepatobililary diseases over a period of 5 years in different hospitals. Most of these patients had cirrhotic liver and during surgery lots of bleeding occurred. We had divided the patients in to two groups. Group 1, n=30 where lab tests were not sent for the clotting factors. Group 2, n=10 lab tests were sent for the clotting factors. In group 1 clotting factors and fresh frozen plasma was replaced when blood was not clotting in peritoneal cavity and in group 2, we sent the lab tests at different intervals during the surgery. Result: It was observed that in Group 1, just by observation we managed the cases of excessive bleeding very well. At the time when blood stopped clotting in the peritoneal cavity, blood by products were transfused while in Group 2, we sent the lab tests frequently to know at what level we had transfuse the blood products. Conclusion: Instead of sending the multiple samples of blood during surgery just we can concentrate that when blood is not concentrating in peritoneal cavity. This may help us in saving cost and time during surgery.