Avoid Blood Transfusion Research Articles

Minimal blood loss living donor hepatectomy.

Donor hepatectomy with maximal safety while preserving graft viability is of principal concern in living donor liver transplantation. There are compelling reasons for avoiding blood transfusion, even with autologous blood, to avoid the potential risks it imposes on healthy donors. This study aims to describe the surgical technique and clinical outcomes of living donor hepatectomy with minimal blood loss requiring no blood transfusion. Donor hepatectomy was performed in 30 living donors according to a detailed preoperative imaging study of the vascular and biliary anatomy. Liver parenchymal transection was carried out with strict adherence to a meticulous surgical technique without vascular inflow occlusion to either side of the liver. Pre-, intra-, and postoperative data were gathered, and factors related to blood loss were analyzed retrospectively. The intraoperative blood loss ranged from 20 to 300 ml with a mean of 72.0+/-58.9 ml (median, 55 ml), and neither homologous nor autologous blood transfusion was required in any of the donors intra- and postoperatively. All 30 donors were discharged with minimal complications, and remain well at a mean follow-up of 24 months after donation. Excellent graft viability was verified by the fact that all 30 recipients are alive and well with a few manageable complications. The actual graft and patient survival are both 100% at the time of writing. Regardless of the extent of donor hepatectomy, blood loss can and should be kept to a minimum, and living donor hepatectomy without blood transfusion is a realistic objective.

Clinical application of a blood pressure autoregulation system during hypotensive anesthesia.

A blood pressure autoregulation system based on the state-predictive control method was developed to minimize intraoperative blood loss and hence avoid blood transfusion. In this report, the system is further improved by incorporating fuzzy logic with a fail-safe function and an individual parameter-identifying function. The safety and stability of this system had been confirmed by preclinical experiments with dogs. Thereafter clinical application with 17 patients was conducted to maintain their mean arterial pressure at around 60 mmHg during major surgery. The use of this system resulted in decreased blood loss and more speedy and accurate surgery due to a clearer surgical field. Unwanted effects of hypotension were not observed clinically or in laboratory tests. This system is therefore safe, stable, and effective in reducing the blood loss during major surgery that otherwise might cause substantial blood loss.

Superior autologous blood stem cell mobilization from dose-intensive cyclophosphamide, etoposide, cisplatin plus G-CSF than from less intensive chemotherapy regimens.

The study purpose was to determine if G-CSF plus dose-intensive cyclophosphamide 5.25 g/m2, etoposide 1.05 g/m2 and cisplatin 105 mg/m2 (DICEP) results in superior autologous blood stem cell mobilization (BSCM) than less intensive chemotherapy. From January 1993 until May 1997, 152 consecutive patients with non-Hodgkin's lymphoma (n = 55), breast cancer (n = 47), Hodgkin's disease (n = 14), multiple myeloma (n = 9), AML (n = 9), or other cancers (n = 18) initially underwent BSCM by one of three methods: Group 1: G-CSF alone x 4 days (n = 30). Group 2: disease-oriented chemotherapy, dosed to avoid blood transfusions, followed by G-CSF starting day 7 or 8, and apheresis day 13 or 14 (n = 82). Group 3: DICEP days 1-3, G-CSF starting day 14, and apheresis planned day 19, 20 or 21 (n = 40). A multivariate analysis was performed to determine which factors independently predicted BSCM. The median peripheral blood CD34+ (PB CD34+) cell count the morning of apheresis linearly correlated with the number of CD34+ cells removed per litre of apheresis that day. The median PB CD34+ cell count and median CD34+ cells x 10(6) removed per litre of apheresis were highest for Group 3, intermediate for Group 2, and lowest for Group 1. By multivariate analysis, mobilization group (3 > 2 > 1), disease other than AML, no prior melphalan or mitomycin-C, and less than two prior chemotherapy regimens predicted better BSCM. Out of 15 Group 3 patients who had infiltrated marrows, 11 had no detectable cancer in marrow and apheresis products after DICEP. These data suggest that DICEP results in superior BSCM than less intensive chemotherapy regimens.

Ligation of internal iliac arteries in pelvic haemorrhage.

To study the value of bilateral ligation of internal iliac arteries in the management of intractable postpartum haemorrhage and to curtail blood transfusion during operations for gynaecological cancers. Internal iliac arteries were ligated in 15 cases of PPH, 4 cases of secondary haemorrhage after hysterectomy and in 27 cases of gynaecological cancers during surgery, over a period of 5 years in a general hospital at Calcutta. The method controlled PPH in all cases except one who required hysterectomy. Secondary haemorrhage was arrested in all. No blood transfusion was necessary during operations for gynaecological cancers except one. The method was effective in 75% of atonic PPH and in majority of PPH due to other causes including caesarean section. It almost entirely avoid blood transfusion during operation for gynaecological cancers. The procedure was simple and did not involve any hazard.

To what extent do parents have the right to decide for their children?

To review the hierarchy of bioethical principles when there are conflicting interests between the medical team and the child's parents in decision making in pediatrics. Our hypothesis is that when the parentś decisions can be questioned, they loose the right to decide for their children. The case of a 9-year-old girl from a Jehova's Witness family is presented. She was a candidate for renal transplantation but her parents were against blood transfusion in case it was required. A member of the medical team presented a denounce to the hospital Medical Ethic Committee and asked for advice. Several materials were reviewed for the ethic aspects involved: the Bioethic Live Plus 1973-4/96, literature provided by people from Jehova's Witnesses, the chapters about ethics in the main pediatric text-books, a journal on Bioethics published by the Brazilian Federal Medical Board, and the Child and Adolescent Act (Brazilian Law 8,069 from January 13th, 1990). The Committee's finding, based on ethic and legal aspects reviewed in the literature about similar cases, favors the beneficence principle under the justification of preserving life as an ultimate goal, and recommends the interference of the Children and Youth Court so that the patient's interest and greater benefits prevail. Nevertheless, it also recommends that the medical team should make every possible effort to avoid blood transfusion in order to respect this conception of life and protect the people who believe in it, in accordance with the fundamental principle of bioethics which postulates the respect for human dignity and autonomy of belief.

Changes in blood transfusion practices after the introduction of consensus guidelines in Mwanza region, Tanzania

To assess the effect of introducing consensus guidelines on avoidable blood transfusions in Mwanza region, Tanzania. Avoidable blood transfusions were determined among 842 blood transfusion recipients in eight hospitals in 1991. In a workshop with senior health workers from the region, consensus guidelines for the prescription of blood transfusions were developed and introduced in the hospitals and after 7 months intervention data were collected on 1042 blood transfusion recipients. The 1991 and 1992 data were compared to estimate the change in the proportion of avoidable blood transfusions. In blood transfusion recipients aged < 5 years there was a significant reduction in the proportion of avoidable blood transfusions from 257 (52%) out of 498 to 197 (33%) out of 595 (P < 0.001), especially at the peripheral hospitals. For children the proportion decreased from 25 to 17% (P < 0.05) and for operated patients the percentage remained at 24%. In pregnant women there was a significant increase in the proportion of avoidable blood transfusions from 10 to 27% and in adults from 37 (25%) out of 146 to 121 (50%) out of 242. The improvement in peripheral hospitals was offset by a similar deterioration in the referral hospital, thus no overall reduction was achieved in the proportion of avoidable blood transfusions. The development and introduction of consensus guidelines was not sufficient to change prescribing practice. The proportion of avoidable blood transfusions decreased only in hospitals where compliance was maintained through regular clinic meetings and strict supervision by senior medical staff.

Sacrococcygeal teratoma: improved haemostasis after aprotinin?

A neonate underwent resection of an extensive sacrococcygeal teratoma after receiving a bolus of 40,000 Kallikrein Inhibitory Units of aprotinin at induction of anaesthesia. The measured blood loss was 30 ml, less than 10% of blood volume, and was replaced with an intravenous colloid solution, avoiding blood transfusion. The blood loss was low compared to previous resections of similar sacrococcygeal teratomas (mean 118 ml, range 60–250 ml) and suggests that aprotinin may be beneficial in blood conservation during extensive dissections in infants.

Hormonal Ergogenic Aids

Most hormonal agents used for nonmedical purposes in athletes have legitimate medical uses. This review introduces each compound by its pharmacology, clinical pharmacology, and legitimate medical use and reviews information on its abuse. Human growth hormone is presently available in virtually unlimited quantities due to its production by recombinant DNA technology. Its use in athletes is considered for its muscle-building, fat-depleting properties. Erythropoietin is a kidney hormone that increases red cell mass. It is used for renal dialysis patients to avoid blood transfusions. Its use in athletes is to raise red blood cell mass in an attempt to augment maximal oxygen capacity and the ability to do endurance work. Human chorionic gonadotropin has the biological activity of luteinizing hormone to increase testosterone synthesis and to maintain (partially) testicular volume when exogenous androgens are taken. Clenbuterol is a beta2adrenergic agonist with muscle-building properties that are seemingly specific to striated muscle; clenbuterol may cause reduction in body fat.

Blood transfusion practices in Mwanza Region, Tanzania

To determine what proportion of blood transfusions given in Mwanza Region, Tanzania could be avoided. A total of 1029 patients who received a blood transfusion in one of eight hospitals were analysed. Two sets of criteria for avoidable blood transfusions were determined, on the basis of a literature review. The following percentages of blood transfusions in five groups of patients were found to be avoidable: operated patients, 8-24%; pregnant women, 8-10%; children aged under 5 years, 31-52%; children aged 5-14 years, 23-25%; and adults, 16-25%. Overall, 23-39% of blood transfusions were avoidable. At least 75% of all avoidable blood transfusions were to children aged under 5 years. The largest reduction of blood transfusions can be achieved in children aged under 5 years, especially in infants aged less than 1 year. Following this study, blood transfusion prescribers drew up provisional guidelines on blood transfusions, which have been introduced in all hospitals in Mwanza Region. An evaluation study has been carried out and is being analysed.

Anemia of Prematurity: The Prospects for Avoiding Blood Transfusions by Treatment With Recombinant Human Erythropoietin

Anemia of Prematurity: The Prospects for Avoiding Blood Transfusions by Treatment With Recombinant Human Erythropoietin

How Well are Hospitals Preventing Iatrogenic HIV?: A Study of the Appropriateness of Blood Transfusions in Three Hospitals in the Ashanti Region, Ghana

A study on the appropriateness of blood and blood product transfusions took place in three hospitals over a 3-week period in July/August 1990 in the Ashanti region of Ghana. Clinical records of all blood transfusion recipients within the period were examined for the appropriateness of the transfusions based on preset criteria. Nearly 1 in 5 (17%) of all blood transfusion episodes in the hospitals were avoidable according to these criteria. Surgical practices were associated, perhaps habitually, with many more avoidable blood transfusions than non-surgical medical practices. The need to minimize the use of transfusion therapy is reemphasized since human immunodeficiency virus screening is imperfect. There is the need for hospitals to develop reasonable, practical guidelines for transfusions in all departments.

Blood salvage in cardiac surgery

The aim of this study was to evaluate blood salvage provided by an intraoperative blood recovery system (IBRS) and a mediastinal drainage blood recovery system (MBRS) during and after cardiac surgery. Sixty-six patients undergoing aortocoronary bypass surgery were randomly assigned to three groups of 22 patients each. In group I, patients received only homologous blood (HB). Group II and group III patients received the blood content of the oxygenator after concentration by an MRS at the end of the operation. In group III, patients also received their own mediastinal drainage blood, shed for 6 hours after operation, after concentration and washing in a MBRS. The patients were transfused with homologous blood if needed, in order to obtain a hematocrit of 28% at the end of operation, 30% the following day, and a hemoglobin level over 10 g/dL while on the cardiac surgery ward (8 to 10 days). The three groups were comparable with respect to age, body surface, preoperative and postoperative hematocrits, number of grafts, bypass duration, and postoperative mediastinal blood loss. The amount of HB that was transfused during the operation was significantly lower in groups II and III than in group I ( P < 0.0001). After the operation it was significantly lower in group 11 than in group I ( P < 0.05), and in group III versus group 1. Thus, 13.6% of patients in group II and 38% of patients in group III did not require HB transfusion. No infection, renal dyfunction, or coagulation disorders were observed. It is concluded that the use of an MRS allows a significant saving of HB. However, because it does not avoid all HB requirements, it should be associated with other techniques to avoid blood transfusion such as the MBRS or predonation.

Acute Hypervolemic Hemodilution to Avoid Blood Transfusion During Major Surgery

TROUWBORST, A.; VAN WOERKENS, E. C. S. M.; DAELE, M. VAN; TENBRICK, R. Author Information

Acute hypervolaemic haemodilution to avoid blood transfusion during major surgery

16 patients underwent acute hypervolaemic haemodilution with dextran 40 and Ringers lactate, to see whether this procedure could avoid preoperative blood transfusion. Packed cell volume (PCV) and oxygen extraction decreased, and cardiac index and pulmonary wedge pressure increased, although end-systolic area was unchanged. PCV was not significantly different between patients who lost less than or greater than 20% of their initial blood volume. This preoperative manoeuvre, which reduces loss of red blood cells, allowed major surgery to be completed safely without blood transfusion.

EFFECT OF HAEMODILUTION ON TRANSFUSION REQUIREMENTS IN LIVER RESECTION

Between April, 1988, and February, 1989, 22 consecutive patients underwent liver resection (17 hepatectomy, 5 segmentectomy) with intraoperative haemodilution to avoid blood transfusion. The results were compared with those of 22 patients who underwent liver resection without haemodilution between February, 1987, and April, 1988, and who were matched for the nature of the tumour and the type of liver resection. Age, preoperative haematocrit and haemoglobin concentration, and intraoperative blood loss did not differ between the groups who did and did not undergo haemodilution. There was no abnormal bleeding during liver transection in haemodiluted patients. No allogeneic blood products at all were needed in a significantly greater proportion of the group with haemodilution than of the group without (19 [86%] vs 6 [27%]). The two groups also showed significant differences in the total requirements of allogeneic packed red cells (haemodilution 9 units, no haemodilution 84 units) and fresh frozen plasma (9 vs 119 units). Although the haematocrit was slightly but significantly lower in the group who underwent haemodilution than in those who did not on postoperative days 1 and 8, the differences had disappeared by the second postoperative month. Postoperative complication rates, abnormal results in liver biochemical tests, and lengths of hospital stay were the same in patients with and without haemodilution. Intraoperative haemodilution in patients undergoing liver resection reduced requirements for all blood products, further lowering the risks associated with liver resection.

Acute Hemodilution in an Anemic Jehovahʼs Witness During Extensive Abdominal Wall Resection and Reconstruction

A 47-year-old anemic Jehovah's Witness with Gardner's syndrome presented with a large abdominal wall desmoid tumor requiring extensive resection with a musculocutaneous flap reconstruction. At surgery a technique of acute limited normovolemic hemodilution (ALNH) was used to minimize blood loss and avoid blood transfusions. Complications that follow transfusions of homologous blood are reviewed, and a recommendation is made to use ALNH because of its advantages in those patients in whom significant blood loss is expected.

Aorto-coronary bypass in Jehovah's Witnesses: Report of 36 patients

Hemodilution technique for cardiopulmonary bypass with the use of bloodless prime has reduced the need for massive blood transfusion in open-heart surgery, including aorto-coronary bypass procedures. Thirty-six Jehovah's Witness patients who had expressed religious convictions against blood transfusion underwent aorto-coronary bypass operations. The mortality rate was 5.5 per cent (2 patients). Neither death was related to the lack of blood transfusions. The hospital stay and the recovery time of all the other patients was also not affected by withholding blood. The excellent short- and long-term results of this particular group paralleled those observed in our series of over 2,500 other patients who have undergone coronary bypass surgery since 1969. About 30 per cent of these patients, who were not Jehovah's Witnesses, did not require blood transfusions, while the remainder averaged less than 2 units per patient. Our results with the Jehovah's Witness patients encourage us in our policy of avoiding blood transfusions whenever possible in all operations. Further justification for our conservative attitude is given by the current shortage of blood in relation to a projected continuous increase of aorto-coronary bypass procedures in the future.

Coagulation defect associated with presumed amniotic fluid embolism in the mid-trimester of pregnancy.

SummaryAn unusual case of disseminated intravascular coagulation is reported. It occurred at about the 20th week of pregnancy and was associated with sudden collapse which appeared to be due to amniotic fluid embolism.The resulting coagulation defect was studied from the time of the initial episode over a period of 130 hours. During this time it was possible to avoid blood transfusion and the alterations in coagulation factors and the fibrinolytic system were measured.