Total Amount Of Blood Loss Research Articles

Pelvic Castleman's disease presenting as an adnexal tumor

Pelvic Castleman's disease presenting as an adnexal tumor

Is Suction Drainage Necessary after Total Knee Arthroplasty?

Purpose: To assess the effectiveness of suction drainage following total knee arthroplasty in terms of blood-saving and local complications. Materials and Methods: A total of 67 patients who underwent primary total knee arthroplasty were evaluated. There were 35 drained and 32 undrained total knee arthroplasties. The total amount of blood loss and transfused were calculated in each patient. Any local or systemic complications were recorded. Results: No significant difference was noted between drained and undrained total knee arthroplasties regarding; wound healing, recovery of knee motion, or associated local or systemic complications. However, blood loss (1078 cc versus 298 cc) and transfusion amounts (2.8 unit versus 0.6 unit) were significantly higher in the drained group than in the undrained group. Conclusion: Following primary total knee arthroplasty, a lack of drainage did not cause significant wound healing problems, but it reduced blood loss and transfusion requirements. Wound drainage following total knee arthroplasty has been a tradition, but this study shows no benefits from a postoperative drainage system in primary total knee arthroplasty.

Tocolytic therapy in conservative management of symptomatic placenta previa

Objectives: To study the effect of ritodrine therapy on maternal and perinatal outcome in cases of symptomatic placenta previa being managed conservatively. Methods: A prospective, randomized controlled clinical trial was made of a total of 60 women whose pregnancies ranged from 28 through 34 menstrual weeks who were randomly allocated to the two study groups using Tippet's random number table. Of these women, 30 were included in the study group where tocolysis with ritodrine was given whereas the other 30 in the control group did not receive tocolysis. Prolongation of pregnancy and birth weight of the newborn were evaluated. The unpaired t-test and chi-square test were used for statistical analysis. Results: Use of tocolysis in symptomatic placenta previa was associated with significant prolongation of pregnancy (25.33 vs. 14.47 days, P<0.05) and difference in birth weight (2270 g vs. 1950 g, P<0.05). There was no observed statistical difference between the two groups with regard to number of episodes of hemorrhage after admission, total amount of blood loss during stay in hospital, number of blood transfusions and maternal complications due to tocolysis in the study group. Conclusions: The present prospective study suggests that ritodrine hydrochloride in patients with symptomatic placenta previa tends to prolong the pregnancy and result in an increase in birth weight of the babies without causing any adverse effect on the mother and fetus.

Use of intravenous tranexamic acid to reduce allogeneic blood transfusion in total hip and knee arthroplasty: a meta-analysis.

Total hip or knee arthroplasty is associated with significant blood loss. Techniques such as the use of antifibrinolytics or desmopressin, or normovolaemic haemodilution have been used to reduce the need for allogeneic blood transfusion. Tranexamic acid has been used to reduce blood loss and transfusion requirement for total hip and knee arthroplasty, with variable results. This meta-analysis aims to evaluate whether intravenous tranexamic acid, when compared with placebo, reduces blood loss and transfusion requirement in total hip and knee joint replacement surgery and whether it might increase the risk of thromboembolic complications. The literature search was based on MEDLINE, EMBASE, Cochrane Controlled Trials Register, and information from the pharmaceutical company that produces tranexamic acid (Pharmacia-Upjohn). We identified 15 clinical trials and 12 were considered suitable for detailed data extraction. Tranexamic acid reduces the proportion of patients requiring allogeneic blood transfusion (OR 0.16, 95% CI: 0.09-0.26), total amount of blood loss (WMD 460 ml, 95% CI: 274-626 ml), and the total number of units of allogeneic blood transfused (WMD 0.85 unit, 95% CI: 0.36-1.33). Tranexamic acid does not increase the risk of thromboembolic complications such as deep vein thrombosis, pulmonary embolism, thrombotic cerebral vascular accident, or myocardial infarction (OR 0.98, 95% CI: 0.45-2.12). Intravenous tranexamic acid appears effective and safe in reducing allogeneic blood transfusion and blood loss in total hip and knee arthroplasty.

Aprotinin in coronary operation with cardiopulmonary bypass: does “low-dose” aprotinin inhibit the inflammatory response?

Background. Cardiopulmonary bypass induces a systemic inflammatory response. Aprotinin, a nonspecific proteinase inhibitor is known to improve postoperative hemostasis and may modify the inflammatory reaction. This study evaluates the effects of low-dose aprotinin on inflammatory markers in patients scheduled for elective coronary artery bypass grafting. Methods. Patients were prospectively randomized into two groups: the control group (C) (n = 14) and the low-dose aprotinin group (A) (n = 15) with (2 × 10 6 KIU = 280 mg) aprotinin added to the pump prime. Cytokine response (interleukin-6, soluble TNF II receptor), terminal complement production (SC5b-9), and neutrophil activation (lactoferrin) were assessed up to 6 hours postoperatively. Clinical data and hemostatic factors including fibrinopeptide A, thrombin-antithrombin complex, D-dimer, and plasmin/α 2-antiplasmin were investigated. Results. In both study groups, a significant increase of all inflammatory markers was seen (IL-6, sTNF-IIR, SC5b-9, lactoferrin), p less than 0.001. Peak levels of complement production occurred after protamine administration, whereas cytokine increases were more pronounced postoperatively with marked elevation up to 6 hours. The markers did not differ significantly between groups throughout the study period ( p > 0.05 at each time of determination). However, after protamine administration reduced fibrinolysis (D-dimer, plasmin/α 2-antiplasmin) was detected in group A. Measurements for coagulation (fibrinopeptide A, thrombin-antithrombin complex) were not significantly influenced by aprotinin. The total amount of blood loss during the first 24 hours was significantly reduced in group A ( p < 0.02). Conclusions. Low-dose aprotinin added to the pump prime does not inhibit the inflammatory response caused by cardiopulmonary bypass, but improves postoperative hemostasis. A potential effect of high-dose aprotinin on inflammatory markers remains to be elucidated.

Development and Practical Use of the New Quantitative Bleeding Time Test Apparatus

We have developed a new computerized system for measurement of quantitative bleeding time (QBT) to detect subtle abnormalities of primary hemostasis that are difficult to detect with the standard bleeding time determination. This new apparatus can simultaneously measure the bleeding time (BT; sec), amount of total blood loss (Tv; microl), maximum bleeding rate (Rmax; microl/sec) and bleeding pattern from the bleeding time incision. We have also developed a new holder for the Simplate that enables more consistent incisions and thus improves the reproducibility of the BT test. In this study, the newly developed QBT test was performed in 137 normal healthy volunteers and 10 patients having defined abnormalities of either primary or secondary hemostasis. Comparisons of the standard BT test and our QBT were made in 5 normal subjects and 7 thrombocytopenic patients. Additionally, 6 normal subjects were examined with both tests before and after administration of aspirin. Those results show that our QBT appears to be a more sensitive indicator of primary hemostasis than the standard BT method.

Epidural Hematoma After Epidural Anesthesia in a Patient with Hepatic Cirrhosis

Epidural Hematoma After Epidural Anesthesia in a Patient with Hepatic Cirrhosis

The use of spinal anesthesia for total hip-replacement arthroplasty

Two hundred and thirty-four total hip replacements in 199 patients performed by one surgeon were reviewed to compare the effects of spinal and general anesthesia. The amount of total blood loss was reduced an average of 600 milliliters in patients under spinal anesthesia. The amounts of operative blood loss, postoperative suction drainage, and blood replacement were also reduced very significantly (p smaller than 0.001). The patients in the two anesthesia groups were similar as to sex, age, body weight, pre-existing medical disease, preoperative medications administered, hip disease, type of prosthesis used, position during surgery, and anticoagulation regimen. The postoperative complications were fewer in the spinal anesthesia group. It is concluded from this study that spinal anesthesia is to be preferred over general anesthesia in patients undergoing total hip replacement.