Amount Of Blood Transfusion Research Articles

Thyroid Function in Chronically Transfused Children with Beta Thalassemia Major: A Cross-Sectional Hospital Based Study.

Background Thalassemia is the most common genetic disorder worldwide. Use of iron chelators has improved survival but endocrine complications have become more frequent. The frequency of hypothyroidism in Beta Thalassemia Major (BTM) children ranges from 6 to 30 %. Thyroid dysfunction mainly occurs by gland infiltration, chronic tissue hypoxia, free radical injury, and organ siderosis. Objectives (a) To evaluate the thyroid function status in chronically transfused children with BTM, in the first and second decade of life and (b) to study the influence of factors like duration and amount of blood transfusions, serum ferritin level, and iron chelation therapy on thyroid function. Methodology BTM children, 3 years old and above, on regular blood transfusions with serum ferritin > 1500 mcg/l were included in the study. Thyroid function and ferritin assessment was done using ELISA kits. Autoimmune thyroiditis was ruled out by antithyroid peroxidase and antithyroglobulin antibody testing. Results A study population of 83 children consisted of 49 boys (59%) and 34 girls (41%). 4.8% of the children had evidence of subclinical hypothyroidism. Among them two belonged to the first decade and the other two to the second decade of life. Mean TSH, FT4, and ferritin values among children with thyroid dysfunction were 6.38 ± 0.83 mIU/ml, 1.08 ± 0.45 ng/dl, and 3983.0±1698.30 ng/ml, respectively. The severity of thyroid dysfunction was statistically significantly associated with higher serum TSH values in children in the second decade of life with a p value = 0.001. No other significant correlation was found between oral chelation, amount and duration of blood transfusion, or serum ferritin levels. Conclusion Subclinical hypothyroidism was the thyroid dysfunction observed in our study. Regular blood transfusions with adequate chelation may decrease incidence of thyroid dysfunction.

Does continued aspirin mono-therapy lead to a higher bleeding risk after total knee arthroplasty?

BackgroundEvidence about the risk of bleeding and thromboembolism because of aspirin mono-therapy in total knee arthroplasty (TKA) is scant. We wanted to validate the risks of bleeding and thromboembolism with continued aspirin mono-therapy in unilateral and simultaneous bilateral TKA. MethodsWe enrolled a series of 1655 patients who underwent unilateral or simultaneous bilateral TKA between December 2010 and December 2012. Drainage amount, postoperative hemoglobin level, change in hemoglobin, calculated blood loss, incidence and the amount of blood transfused, and the proportion of thromboembolic events were compared between patients who were and patients who were not on continued aspirin mono-therapy. ResultsCalculated blood loss (969.1 ± 324.9 vs. 904.0 ± 315.5 ml), transfusion amounts (1.3 ± 1.5 vs. 1.0 ± 1.3 IU), and percentage of transfused patients (53.0% vs. 40.2%) were higher in unilateral TKA patients on continued aspirin mono-therapy. Outcome parameters and the proportion of DVT between groups were not significantly different. One patient (0.3%) not on aspirin mono-therapy developed a pulmonary embolism, and two others (0.6%) had cerebrovascular events. ConclusionDespite the slightly higher risks of bleeding, continuing aspirin mono-therapy during TKA might be safe with low risks of perioperative cerebrovascular, cardiovascular, and venous thromboembolic events.

Pedicle Subtraction Osteotomy Versus Multiple Posterior Column Osteotomies in Severe and Rigid Neuromuscular Scoliosis.

Retrospective analysis. The aim of this study is to compare the safety and efficacy of the apical pedicle subtraction osteotomy (PSO) technique with multiple posterior column osteotomies (PCOs) in nonambulatory patients with severe, rigid neuromuscular scoliosis. Neuromuscular scoliosis frequently causes intolerance to sitting due to pelvic obliquity, trunk decompensation, and associated back and rib impingement pain which diminish the patient's functional capacity. In the case of rigid curves, spinal osteotomy techniques are occasionally required for effective correction. We retrospectively reviewed our patients with severe and rigid neuromuscular scoliosis with associated pelvic obliquity who were treated with posterior instrumented fusion extending to pelvis with more than 1-year postoperative follow-up. We compared radiological and clinical results of PSO and multiple PCO techniques in severe rigid neuromuscular scoliosis with pelvic obliquity of more than 15° in traction radiograph under general anesthesia. Hospital records were also reviewed for operative time, intraoperative blood loss, amount of blood transfusion, duration of hospital stay, and complications. There were 12 patients in the PSO group and 10 patients in the PCO group. There was no significant difference between groups in terms of major curve magnitude, sagittal parameters or pelvic obliquity. Although not statistically significant, PSO technique did trend toward better scoliosis correction (post-op Cobb angle 56.1° vs. 66.7° [P = 0.415]). PSO technique provided a significantly better correction in pelvic obliquity (59% vs. 84%) (P = 0.001). There was no significant difference in average intraoperative blood loss, transfusion, and operative times including anesthesia time, hospital stay, or complications. PSO may be an option in correction of severe and rigid neuromuscular scoliosis. It provides better correction of pelvic obliquity without increasing operative time, need for transfusion, or duration of hospitalization as compared to multiple apical PCO technique. Traction radiograph under general anesthesia is a valuable tool in surgical decision making. 4.

The Natural History of Hematemesis in the 21st Century.

Objective: Upper gastrointestinal (GI) bleeding occurs at a rate of 40-150 episodes per 100,000 persons per year and is associated with a mortality rate of 6%-10%. We sought to determine the need for therapeutic endoscopy or surgical interventions in patients with hematemesis and the association with blood transfusion requirements.Methods: We queried the database of our large teaching facility for adult patients presenting with obvious upper GI hemorrhage (hematemesis) between 2014 and 2017. We evaluated the amount of blood transfusions administered and the need for operative, endoscopic or angiographic interventions.Results: Eighty-one patients were admitted with hematemesis: mean age was 63 years old (range 21-103), 60% were male, and mean hemoglobin was 11.3 g/dL (range 3.6-15.6). Forty-one percent received blood transfusions with a mean of one unit transfused per patient (range 0-10); 9% received ≥ 3 units of packed red blood cells. Bleeding stopped spontaneously in 88% of patients and nine died. Forty-seven percent underwent inpatient endoscopy but only 6% underwent a therapeutic endoscopic intervention. No patient had a surgical or interventional radiologic procedure related to their GI bleed.Conclusion: Upper GI bleeding rarely requires operative or interventional radiologic intervention. Blood transfusions were not predictive of the need for therapeutic endoscopic intervention which was required in only 6% of patients.

Logistic regression analysis of risk factors for primary graft dysfunction after lung transplantation

Objective: To explore the risk factors of primary graft dysfunction (PGD) after lung transplantation and provide a new therapeutic strategy for PGD. Methods: A retrospective analysis of lung transplant patients from January 2014 to July 2017 in Henan Provincial People's Hospital.According to the PGD classification standard established by the International Society for Heart and Lung Transplantation, the association of potential risk factors with PGD was analyzed by using multivariable Logistic regression. Results: Fourteen of 30 patients (46.7%) developed grade 3 PGD.There was no significantly statistical difference in gender, etiology, duration of anesthesia, amount of blood transfusion, amount of blood transfusion and donor gender(all P>0.05). Body mass index (BMI), donor pulmonary cold ischemia time, duration of operation, extracorporeal membrane lung oxygenator (ECMO), systolic pulmonary arterial pressure and donor smoking history were all higher than those of non-PGD patients (all P<0.05). Independent risk factors for PGD were donor pulmonary cold ischemia time (OR 1.032, 95%CI 1.000-1.065, P=0.048); systolic pulmonary arterial pressure (OR 1.258, 95%CI 0.969-1.632, P=0.007); donor smoking (OR 8.879, 95%CI 1.096-71.913, P=0.041). Conclusion: Donor pulmonary ischemic time, systolic pulmonary arterial pressure and donor smoking history are PGD risk factors, which provide new ideas for PGD treatment.

Surgical repair via submammary thoracotomy, right axillary thoracotomy and median sternotomy for ventricular septal defects

BackgroundRight submammary thoracotomy and right vertical infra-axillary thoracotomy are performed for ventricular septal defect (VSD) to reduce the invasiveness of the conventional surgical repair through median sternotomy approach. No comparative studies have been conducted among these three procedures.MethodsFrom January 2016 to December 2016, 182 patients with isolated VSD who underwent surgical repair via one of these 3 approaches were reviewed to compare these three procedures.ResultsThe procedure success rates were similar in these three groups. There was no statistically significant difference in operative time, aortic cross-clamping time, the duration of CPB, blood transfusion amount and medical cost. However, postoperative mechanical ventilation time, the duration of intensive care and postoperative length of hospital stay were longer in median sternotomy group than the other two groups. (P < 0.05) The median sternotomy group required the longest incision. No significant difference was noted in major adverse events. There were different advantages and disadvantages in the three kinds of operative procedures.ConclusionsRegarding conventional surgical repair VSD, right submammary thoracotomy and right vertical infra-axillary thoracotomy both delivered better cosmetic results for patients with isolated VSD, while all the three procedures could obtain satisfactory clinical effect.

Can Low-dose Tranexamic Acid Decrease Blood Loss and Transfusion Requirements in Total Knee Arthroplasty?

IntroductionTranexamic acid (TA) has been used successfully in primary total knee arthroplasty (TKA) to minimize blood loss and transfusions. The aim of this study was to evaluate the effect of perioperative single low-dose TA administration on postoperative blood loss and necessity for blood transfusion in patients undergoing total knee arthroplasty under spinal anesthesia.Material and MethodsData of patients undergoing TKA between January 2013 through December 2015 were retrospectively reviewed. Patients that underwent unilateral knee arthroplasty under spinal anesthesia were separated into two groups: those where TA was used (10 mg/kg) and a control group where TA was not used. The following data were collected from medical records and compared between groups according to demographics, hemoglobin levels, and drainage amount.ResultsA total of 48 patients' data were evaluated (TA: 20; control: 28). The use of tranexamic acid in total knee arthroplasties seemed to reduce the postoperative drainage rate and blood transfusion requirement. Average 24-hour drainage levels were significantly lower in the TA group when compared to the control group. Required 24-hour total blood transfusion amounts were significantly higher in the control group. There was no difference in preoperative and postoperative sixth or 24th-hour hemoglobin levels between the groups.ConclusionA low or single dose of TA is a safe and effective agent that significantly lowers blood loss and allogeneic blood transfusion requirements.

Clinical Outcomes of VasoRing Connector in Patients With Acute Type A Aortic Dissection

Outcomes of acute type A aortic dissection repair may be improved when VasoRing connectors (VRC [Sunwei Technology, Taipei, Taiwan]) are used to facilitate aortic anastomosis. In the present study, we compared the results of acute type A aortic dissection repair using VRC and conventional suture technique. A total of 68 patients who underwent acute type A aortic dissection repair by total arch replacement and antegrade frozen elephant trunk procedure at our institution were enrolled. Records of patients receiving aorta anastomosis with VRC (n= 33) and conventional suture (n= 35) were retrospectively compared. All the surgical results were collected and analyzed. The results showed that the VRC group exhibited significance in total operative time (326 ± 80 minutes versus 362 ± 34 minutes, p= 0.023), cardiopulmonary bypass time (97 ± 10 minutes versus 134 ± 15 minutes, p < 0.001), aortic cross-clamp time (97 ± 10 minutes versus 134 ± 15 minutes, p < 0.001), and circulatory arrest time (15 ± 4 minutes versus 50 ± 8 minutes, p<0.001) compared with the suture group. Use of VRC for aortic anastomosis led to significantly less perioperative blood loss (442 ± 75 mL versus 849 ± 419 mL, p<0.001) compared with conventional suture for aortic anastomosis There was no reoperation for postoperative bleeding in the VRC group whereas reoperation for postoperative bleeding occurred in 20% of the suture group (0% versus 20%, p= 0.011). Postoperative blood loss, amount of blood transfusion, and acute kidney injury requiring hemodialysis were also significantly less in the VRC group than the suture group. Use of VRC shortened operative time and improved bleeding control incorporating standard methods for aortic anastomoses during acute type A aortic dissection repair by total arch replacement and antegrade frozen elephant trunk procedure. Long-term follow-up and randomized comparison are needed to confirm VRC efficacy.

Esmolol hypotension maintains tissue perfusion during myomectomy judged by Masimo monitoring of regional cerebral oxygen saturation and pleth variability index

ObjectivesTo evaluate outcome of elective abdominal myomectomy under esmolol hypotensive anesthesia (HA) compared to normotensive anesthesia (NA).MethodsPatients were randomly divided into NA Group received NA and HA Group received esmolol (0.5 mg/kg) bolus then infusion (0.05–0.3 mg/kg/min) to maintain mean arterial pressure at 60–70 mmHg till completion of myomectomy. Masimo Radical 7 was used to monitor regional cerebral oxygenation (rSO2), total hemoglobin (Hb.) and pleth variability index (PVI). Fluid therapy (FT) included initial bolus of 5% human plasma protein followed by intraoperative (IO) Lactated Ringer's (LR) solution. Amount of IO blood loss, blood transfusion and urine output (UOP) were determined. Postoperative (PO) Hb. conc. was measured at laboratory (Lab).ResultsIO blood pressure was significantly lower, while PVI was significantly higher with significantly lower ΔPVI with HA than NA. Operative time was significantly shorter with significantly less IO blood loss and blood transfusion with HA. Regional cerebral and peripheral tissue oxygen saturations showed non-significant difference between both groups. PO Masimo measured and Lab estimated Hb. was significantly higher with significantly lower ΔHb% in HA than NA group. Masimo measurement was significantly higher with significantly lower ΔHb% than lab estimation in both groups. Patients of NA group received significantly greater amount of LR, but UOP was non-significantly higher than in HA group.ConclusionEsmolol HA allowed better control of IO bleeding, blood transfusion and FT. Masimo continuous monitoring of rSO2 assured preserved cerebral perfusion. Masimo measured PVI could non-invasively monitor tissue perfusion.

Analysis of Efficacy of Tranexamic Acid in Reduction of Blood Loss and Postoperative Blood Transfusions Following Orthopedic Trauma Surgery

ABSTRACT Introduction Perioperative and postsurgical hemorrhage is common in invasive surgical procedures, including orthopedic surgery. Tranexamic acid (TXA) is a pharmacologic agent that acts through an antifibrinolytic mechanism to stabilize formed clots and to reduce active bleeding. It has been used successfully in orthopedics to reduce perioperative blood loss, particularly in total hip and knee arthroplasty and spine surgery. Ischemia increases fibrinolysis, related to the proteolytic action of plasmin, with a subsequent fibrinogen scission, which limits postoperative coagulation and favors bleeding. Tranexamic acid being antifibrinolytic acts to prevent this effect from taking place. This study was designed to assess the efficacy of TXA in reducing blood loss and postoperative blood transfusions following the fixation of fracture of both bones of leg with intramedullary interlocking nailing of tibia done by open method. Study design Randomized, prospective, comparative study. Materials and methods In this study, patients were randomly allocated into two groups of 25 each. Group I received inj. TXA and group II received inj. normal saline. Preoperative hemoglobin (Hb), postoperative Hb, total blood volume (BV), blood loss, and Hb loss were compared between two groups. Statistical analysis was done with Fisher's t test and Fisher's exact test. Results The mean blood loss in TXA and placebo group was 249.02 ± 57.04 mL and 543 ± 83.64 mL, respectively, and found to be highly significant (p value &lt; 0.001). A number of patients required blood transfusion were significantly low in TXA group than in placebo group (p &lt; 0.01). Conclusion This study indicated that TXA results in significant reduction in blood loss (nearly 60%) and amount of blood transfusion required in patients undergoing surgery. Routine administration of TXA may benefit patients undergoing surgery where significant blood loss is expected. How to cite this article Kingsly P, Sathish M, Ismail NMDM. Analysis of Efficacy of Tranexamic Acid in Reduction of Blood Loss and Postoperative Blood Transfusions Following Orthopedic Trauma Surgery. J Orth Joint Surg 2019;1(1):27–30.

Fractures of the femur and blood transfusions

BackgroundBlood loss estimation after trauma (i.e. physical injury) and early identification of potential sources of bleeding are important for planning of investigation and management of trauma. Long bone fractures have been reported to be associated with substantial volumes of blood loss requiring blood transfusion. The aim of this study was to assess rates and amounts of blood transfusion in the setting of isolated extra capsular femur fractures and to determine variables associated with the need for transfusion within the first 48 h of admission. MethodsA retrospective cohort study was conducted of patients in The Alfred Trauma Registry with isolated extra capsular femur fractures over a 7-year period. We compared patients with a femoral shaft fracture (FSF) to patients with either distal femur or proximal femur fractures (i.e. extremity fracture). We collected data potentially associated with blood transfusion within 48 h as well as operation details and patient outcomes. ResultsThere were 293 patients included, of which 121 had FSF and 172 extremity fracture. 105 (36%) patients received a blood transfusion during their admission. Admission haemoglobin (AOR 0.92; 95%CI 0.89–0.94, p < 0.01) was the only independently associated variable with blood transfusion within the first 48 h of hospital admission. ConclusionVolume of blood transfused to patients with extra-capsular femoral fractures was low and usually in the post-operative period. FSF, compared to femoral extremity fractures, were not more likely to receive blood transfusion within the first 48 h of admission, and did not receive a higher volume of blood overall. In the setting of major trauma with haemorrhagic shock, alternate sources of bleeding should be sought.

Intraoperative blood transfusion in pediatric patients undergoing renal transplant-Effect of renal graft size.

In pediatric RT, donor allograft size often exceeds the expected recipient norms, especially in younger recipients. An "oversize" graft might not only present a technical- and space-related challenge, but may possibly lead to increased demands in perioperative volume requirements due to the disparity between donor and recipient in renal blood flow. We evaluated transfusion practices at a single tertiary institution with special consideration of kidney graft size, hypothesizing that oversize graft kidneys might lead to a quantifiable increased need of blood transfusion in smaller recipients. Retrospective analysis of all patients who underwent pediatric RT from January 2004 to June 2014 at a tertiary pediatric centre was performed. Variables analyzed included patient age, weight, pre- and postoperative Hb concentration, graft size, EBL, amount of intraoperative blood transfusion, and preoperative use of erythropoietin. Based on graft size in relation to patient's age, a SMR and an OvR were identified. A subcohort of age-matched pairs was used to allow for comparison between groups. We calculated the expected procedure- and transfusion-induced changes in Hb and compared these changes to the observed difference in pre- vs postoperative Hb to assess the influence of graft size on transfusion requirements. RT was performed in 188 pediatric recipients during the study period. In the matched cohort, percentage of transfused patients during transplantation in the OvR group was more than double compared with SMR (89% vs 39%, P<.001); similarly, the median number of transfused PRBC units in OvR was 1, while the median of SMR did not receive transfusion (P<.001). The difference between expected (calculated) and observed change in Hb was significantly higher in OvR with a median of 1.9g/dL compared with SMR with a median of 1.0g/dL (P=.026). Correspondingly, the calculated median volume taken up by a regular size kidney was significantly higher with 213mL compared with 313mL (P=.031) taken up by an oversize graft kidney. Median estimated intraoperative blood loss was significantly higher in OvR than in SMR (6.9mL/kg, vs 5.3mL/kg, respectively; P=.04). Median postoperative Hb was similar among groups (10.4g/dL vs 10.6g/dL for SMR vs OvR, respectively). Transplantation of an oversized kidney in pediatric RT recipients is associated with a quantifiable higher need for blood transfusion. This may be caused by a higher intraoperative EBL and/or greater blood volume sequestered by the larger renal allograft and requires further evaluation.

Thoracoscope-Assisted Mitral Valve Replacement with a Small Incision in the Right Chest: A Chinese Single Cardiac Center Experience.

BackgroundThe aim of this study was to investigate the safety, feasibility, and clinical effectiveness of thoracoscopy-assisted mitral valve replacement via thoracic right-anterior minimal incision.Material/MethodsA retrospective analysis was conducted of 225 patients with mitral valve lesions who were treated in our hospital from August 2012 to August 2015. Group A included 105 patients undergoing thoracoscopy-assisted mitral valve replacement via a thoracic right-anterior minimal incision, and group B included 120 patients undergoing conventional mitral valve replacement. We collected and analyzed clinical data from both groups.ResultsThe procedures were successful in patients of both groups. No severe complications or mortality were reported. Postoperative mechanical ventilation time (8.6±2.4 h vs. 12.4±3.2 h), duration of intensive care (1.7±1.2 d vs. 2.8±1.3 d), duration of postoperative analgesia use (28.7±8.9 h vs. 36.3±7.5 h), postoperative length of hospital stay (8.2±2.2 d vs. 12.8±2.1 d), pleural fluid drainage (210.5±60.5 ml vs. 425.4±75.6 ml), blood transfusion amount (420.5±80.4 ml vs. 658.3±96.7 ml), and operative incision length (4.7±1.1 cm vs. 22.4±2.5 cm) were significantly shorter (or lower) in group A than in group B. There were different advantages and disadvantages in the 2 kinds of operative procedure in terms of postoperative complications.ConclusionsThoracoscopy-assisted mitral valve replacement via thoracic right-anterior minimal incision has the same clinical efficacy, safety, and feasibility as conventional mitral valve replacement.

Intermittent Pringle Versus Continuous Half-Pringle Maneuver for Laparoscopic Liver Resections of Tumors in Segment 7.

Segment 7 is considered an unfavorable portion for laparoscopic hepatectomy because of technical difficulties in exposure and controlling bleeding. We compared intermittent Pringle with continuous half-Pringle maneuver in laparoscopic liver resections of tumors in segment 7. A retrospective analysis was conducted in a total of 36 consecutive patients with tumors in segment 7 undergoing laparoscopic liver resections between July 2011 and February 2016 (16 in the Pringle group versus 20 in the half-Pringle group). The two groups were well matched in baseline characteristics. The operative time (274.5 ± 34.3 versus 237.6 ± 41.8min), overall declamping time (28.4 ± 8.6 versus 2.3 ± 2.5min), and ischemic duration (69.7 ± 16.5 versus 52.7 ± 13.2min) were significantly longer in the Pringle group (P < 0.05). The amount of intraoperative blood loss (612.5 ± 222.3 versus 417.4 ± 163.8mL) and transfusion (335.2 ± 58.7 versus 224.8 ± 76.2mL) was significantly greater in the Pringle group (P < 0.05). The Pringle group was associated with significantly lower postoperative albumin and higher C-reactive protein levels on postoperative days 1, 3, and 7 (P < 0.05). Laparoscopic hepatectomy for tumors in segment 7 can be performed safely and effectively with successful exposure of surgical field and proper hepatic blood flow occlusion. Continuous half-Pringle maneuver offers the advantages of less operative time and blood loss, less injury, and better recovery.

Application of sodium citrate in continuous renal replacement therapy

Objective To discuss the anticoagulation effects and safety of sodium citrate in continuous renal replacement therapy (CRRT) . Methods A total of 140 cases who underwent CRRT in the intensive care unit (ICU) of Zhejiang Provincial People′s Hospital from January 2014 to December 2016 were selected as research objects and divided into the heparin sodium group (n=56) , the low molecular weight heparin calcium group (n=48) and the sodium citrate group (n=36) according to the anticoagulation methods. The differences of anticoagulation effects, the average service life of the pipelines, the overall pipeline quantity, the total cost of blood purification, the blood transfusion amount during CRRT, total bilirubin (Tbil) , serum creatinine (Cer) , Na+, K+, prothrombin time (PT) , activated partial prothrombin time (APTT) , platelet count (PLT) before and after CRRT and the complications related to CRRT among the three groups were compared. Results The anticoagulation effect of the sodium citrate group was obviously better than that of the other two groups (χ2=18.809, P<0.05) . The average service life of the pipelines of the sodium citrate group was (29.3±5.4) h, which was obviously higher than that of the heparin sodium group (16.5±3.5) h and the low molecular weight heparin calcium group (24.8±4.1) h, and the intergroup difference was statistically significant (F=6.596, P<0.05) . The transfusion amount of red blood cells, plasma and platelets of the sodium citrate group was (12.3±2.8) U, (1 875.5±198.6) ml and (23.5±8.6) U, which was obviously lower than that of the heparin sodium group [ (16.5±5.6) U, (2 463.4±265.4) ml and (58.3±18.5) U] and the low molecular weight heparin calcium group [ (13.4±3.2) U, (1 954.4±214.5) ml and (32.6±11.5) U], and the intergroup differences were all statistically significant (F=4.563, 3.896, 7.456; P<0.05) . The Tbil, Cer, Na+ and K+ of all groups decreased after CRRT, and the differences were all statistically significant (P<0.05) . There were statistical significance in PT, APTT and PLT among the three groups (F=4.562, 4.153, 5.468; P<0.05) . The PLT of the sodium citrate group increased significantly after CRRT, with statistical difference (P<0.05) . The incidence rate of hemorrhages in skin, digestive tract, puncture point and trachea of the sodium citrate group was respectively 2.8%, 5.6%, 2.8% and 5.6%, which was obviously lower than that of the heparin sodium group (23.2%, 12.5%, 16.1%, 12.5%) and the low molecular weight heparin calcium group (6.3%, 10.4%, 8.3%, 8.3%) , and the differences were all statistically significant (χ2=6.678, 7.553, 6.849, 7.534; P<0.05) . The incidence rate of heparin induced thrombocytopenia (HIT) of the heparin sodium group was 8.9% (5/56) . Conclusions The anticoagulation effect of sodium citrate in CRRT is remarkable with less complications. It can significantly reduce the amount of blood transfusion and the cost of blood purification and is worth of promotion in clinical application. Key words: Continuous renal replacement therapy; Sodium citrate; Anticoagulation effect; Complications

Primary total knee arthroplasty with or without the use of tourniquet

Introduction Total knee arthroplasty (TKA) may be the only effective treatment available to reduce pain and restore joint mobility and function in case of advanced osteoarthritis of the knee. The major benefit of TKA with the use of tourniquet is operating in a bloodless field. A possible secondary benefit is a better cement bone interface for fixation. However, the use of tourniquet in TKA is associated with multiple risk factors both local and systemic. The aim of this work To compare between the use or nonuse of tourniquet on patients operated for TKA. Patients and methods This study included 30 TKA in 30 patients. The comparison was made between 15 TKA done with the use of tourniquet in 15 patients (group A) and 15 TKA done without the use of tourniquet in the next consecutive 15 patients (group B). Full preoperative assessment including clinical, laboratorial, and radiological examination with routine investigations was done for every patient. The intraoperative blood loss and the need for and amount of blood transfusion were estimated. Immediate postoperative assessment included the estimation of hemoglobin level, blood loss, and need for and amount of blood transfusion. The 3-month postoperative evaluation included the pain by visual analog scale, range of knee flexion, and time to straight leg raising. Results There was no major operative complication during the procedures. Intraoperative blood loss was higher in group B (1273.3±430.1 ml), and postoperative blood loss was higher in group A (623.3±161.0 ml). Overall, 60% of group B patients had increased need for blood transfusion. Moreover, 26.7% of patients in group A compared with 6.7% of patients in group B had severe postoperative pain on the visual analog scale. The mean time to straight leg raising was 6.67±1.18 weeks in group A and 4.73±0.70 weeks in group B. The mean range of knee flexion was 118.33±5.56° in group A and 124.80±3.91° in group B after 3 months. Conclusion TKA done without the use of tourniquet is accompanied by more intraoperative blood loss and increased need for both intraoperative and postoperative blood transfusion. TKA without the use of tourniquet accelerates the recovery of knee flexion range and shortens the time for straight leg raising.

Single intravenous bolus versus perioperative continuous infusion of tranexamic acid to reduce blood loss in abdominal oncosurgical procedures: A prospective randomized double-blind clinical study.

Background and Aims:Intraoperative use of a single bolus dose of tranexamic acid may not be sufficient to prevent bleeding in the early postoperative period. The present study was carried out to compare the effect of two dose regimens of tranexamic acid in reducing perioperative blood loss and the amount of allogenic blood transfusion in abdominal tumor surgery.Material and Methods:In this prospective, controlled, and double-blind investigation, 60 patients electively posted for abdominal oncosurgical procedures were randomly assigned to receive a single bolus dose of tranexamic acid (10 mg/kg) (Group A), a bolus dose of tranexamic acid (10 mg/kg) followed by infusion (1 mg/kg/h) till 4 h postoperatively (Group B), and a bolus followed by infusion of normal saline (group C). Total intraoperative blood loss, amount of allogenic blood transfusion, postoperative drain collections, and hemoglobin and hematocrit levels were recorded at different time intervals. Data obtained after comparing three groups were analyzed by analysis of variance test for variables following normal distribution, Kruskal–Wallis test for nonparametric data, and post-hoc Tukey–Kramer test for intergroup analysis. A probability value of less than 5% was considered significant.Results:There was no significant difference in intraoperative blood loss in all the three groups. Both the tranexamic acid groups showed reduction in postoperative blood collection in drain at 6 h and 24 h in comparison to the control group (P < 0.001). There was also a significant difference in the amount of blood in postoperative drain at 24 h within the tranexamic acid groups, where lesser collection was seen in the infusion group (P = 0.007). Hemoglobin and hematocrit levels measured at different postoperative time intervals showed a significant reduction from the baseline in the control group compared to the tranexamic acid groups together.Conclusion:Tranexamic acid causes more effective reduction in post-operative blood loss when used as a bolus followed by an infusion continued in the postoperative period in comparison to its use as a single intravenous bolus in abdominal tumor surgery.

Minimal Invasive Technique in Atrial Septal Defect Surgery.

BackgroundMedian sternotomy with minimal skin incision (MSWMSI) and modified anterior mini-thoracotomy (MAMT) approach that both are innovative techniques modified from previous documented techniques are important alternative to conventional median sternotomy in atrial septal defect (ASD) repair. Our aim is to explain the details of two performed techniques in our center and explain the results.MethodsTotally 54 children with ASD (20 female and 34 male) were operated with two different techniques i.e. MAMT and MSWMSI in Imam Ali heart surgery center between May 2010 and May 2013. Intra and postoperative variables such as cardiopulmonary bypass time and aortic cross-clamp time, intensive care unit stay time, length of incision, postoperative hematoma and seroma, dehiscence mortality, exploration for postoperative bleeding, neurologic complication, infection and amount of blood transfusion were recorded.ResultsMean cardiopulmonary bypass time was 30 ± 11 min, and mean aortic cross-clamp time was 7 ± 2 min. The mean amount of blood transfusion was 150 ± 39 mL, and the mean chest tube drainage after surgery was 140 ± 57 mL. Superficial skin infection occurred in three patients. Subcutaneous hematoma and seroma were founded in six patients. In 50 cases the defect was secundum type, in two patients it was sinus venosus type, and in two with associated perimembranous ventricular septal defect repair.ConclusionBoth approaches are safe and may be the surgical techniques of choice for secundum ASD repair in all age groups; and we can also utilize these techniques for more complicated kinds of surgery, for instance, sinus venosus type ASD with or without partial anomalous defect.

Chronic Obstructive Pulmonary Disease and Off-Pump Coronary Surgery.

Purpose: To determine to what extent chronic obstructive pulmonary disease (COPD) affects mortality and morbidity rates in patients treated with off-pump coronary artery bypass graft (CABG).Methods: A total of 321 patients treated with off-pump CABG were included in the present study. Of the 321 patients, 46 patients had COPD and they were designated as Group 1 and the remaining 275 patients did not have COPD and they were considered as Group 2. We compared the data obtained from the patients in both groups.Results: While preoperative spirometry values and arterial blood gas oxygen saturation levels were significantly lower, the partial values of carbon dioxide were higher in Group 1. Likewise, extubation time, the amount of drainage and blood transfusion, inotropic support, prolonged intubation, pulmonary complications, the use of bronchodilators, and steroids were statistically higher in Group 1 when compared with Group 2. Overall, there was no marked difference between the two groups in terms of mortality incidence.Conclusion: We found similar morbidity and mortality rates among the patients with COPD and without COPD when they were treated with off-pump CABG. Therefore, the present results indicate that the presence of COPD is not associated with in-hospital mortality or severe morbidity post-CABG by off-pump approach.

Evaluation of local intra-pleural application of tranexamic acid on postoperative blood loss in lung decortication surgery, a prospective, randomized, double-blind, placebo-controlled study.

Background:During decortication surgery, fibrous peel over the lung was removed to allow expansion of the lung and therefore, wide raw area was created with surface oozing. The phenomenon of fibrinolysis usually activated after such procedure, resulting in increasing the postoperative bleeding. Tranexamic acid is one of antifibrinolytic therapies that could be used topically and to targets directly the source of bleeding and reducing the local activation of the fibrinolytic process and consequently reducing the postoperative bleeding.Patients and Methods:A total of 70 patients underwent lung decortication surgery in Cardiothoracic Surgery Department at Tanta University Hospital from January 2015 to May 2017. Patients were randomly allocated into two groups, Group I (35 patients) receiving 3 g of tranexamic acid in 100 ml of saline solution and Group II (35 patients) receiving 100 ml of saline solution as placebo. At the end of the operation and before closing the chest, in both groups, drug or placebo solution was distributed locally all over the pleural cavity. Comparison between the groups was done regarding the amount of postoperative bleeding, postoperative hemoglobin in the first 24 and 48 h postoperatively, blood transfusion, Intensive Care Unit (ICU) stay, and hospital stay.Results:Both groups were comparable regarding demographic and surgical data. Group I patients had the significantly lesser amount of postoperative blood loss than Group II during the first postoperative 48 h, and hence, the need of postoperative blood transfusion was significantly lower in Group I with better postoperative hemoglobin level than Group II. However, there was no difference in overall ICU and hospital stay.Conclusion:The local intrapleural use of tranexamic acid after decortication surgery of the lung is safe and significantly reduces the amount of postoperative blood loss and in consequence reduces the amount of postoperative blood transfusion.