Blood Loss In Surgical Patients Research Articles

Iron deficiency: effects beyond anaemia?

The surgical risks associated with anaemia, particularly iron deficiency anaemia, have been addressed extensively in the past few decades. In 2010, WHO encouraged all member states to implement patient blood management programmes, providing multiple strategies to increase and preserve autologous erythrocyte volume and to ensure guideline adherent transfusion of red blood cells.1 The main principles of patient blood management are to detect and treat preoperative anaemia, to maintain haemoglobin concentration during hospital stay, to optimise blood haemostasis, and to minimise blood loss in surgical patients.

PSY9 - Aprotinin free Hemostatic sealant to reduce Blood loss in Surgical Patients: a systematic review

PSY9 - Aprotinin free Hemostatic sealant to reduce Blood loss in Surgical Patients: a systematic review

Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss

Tranexamic acid (TXA) reduces blood transfusion in surgery but the extent of the reduction in blood loss and how it relates to the dose of TXA is unclear. A systematic review of randomized trials was performed. Data were extracted on blood loss from trials comparing intravenous TXA with no TXA or placebo in surgical patients. A Bayesian linear regression was used to describe the relationship between the reduction in blood loss with TXA and the extent of bleeding as measured by the mean blood loss in the control group. A meta-analysis of the log-transformed data was conducted to quantify the effect of TXA on blood loss, stratified by type of surgery, timing of TXA administration and trial quality. Meta-regression was used to explore the effect of TXA dosage. Data from 104 trials were examined. Although the absolute reduction in blood loss with TXA increased as surgical bleeding increased, the percentage reduction was similar. TXA reduced blood loss by 34 per cent (pooled ratio 0·66, 95 per cent confidence interval 0·65 to 0·67; P < 0·001). The percentage reduction in blood loss with TXA differed by type of surgery, timing of TXA administration and trial quality, but the differences were small. The effect of TXA on blood loss did not vary over the range of doses assessed (5·5-300 mg/kg). TXA reduces blood loss in surgical patients by about one-third. A total dose of 1 g appears to be sufficient for most adults. There is no evidence to support the use of high doses.

The correlation of memory impairment with intraoperative blood loss in surgical patients and the nursing interventions

Objective To explore the correlation of blood loss with memory impairment in patients during surgical process and the related nursing interventions.Methods 68 patients who had received surgical treatment during the period of March 2009 to January 2012 were divided into small amount group (＜ 300 ml) and large amount group (≥ 300 ml) according to the amount of intraoperative bleeding.The differences in clinical data were compared between the two groups.Results The rate of memory impairment was 29.12％ higher in large amount group than in small amount group.The rate of impairment was 23.68％ for slight impairment,26.32％ for moderate impairment,and 15.79％ for severe impairment in large amount group and 16.67％,16.67％,and 3.33％ in small amount group,respectively (P ＜ 0.05).Conclusions The amount of blood loss is markedly associated with o the incidence of postoperative memory impairment.Nursing staff should actively cooperate with surgeons and improve their professional skills to avoid occurrence of low body temperature in patients during surgery.Comprehensive,timely,effective nursing care can lower incidence of postoperative memory impairment. Key words: Postoperative memory impairment; Intraoperative blood loss; Nursing care

CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage) intracranial bleeding study: the effect of tranexamic acid in traumatic brain injury, a nested randomised, placebo-controlled trial.

Tranexamic acid (TXA) has been shown to reduce blood loss in surgical patients and the risk of death in patients with traumatic bleeding, with no apparent increase in vascular occlusive events. These findings raise the possibility that it might also be effective in traumatic brain injury (TBI). The Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage Intracranial Bleeding Study (CRASH-2 IBS) was conducted to quantify the effect of an early short course of TXA on intracranial haemorrhage and new focal cerebral ischaemic lesions in patients with TBI. CRASH-2 IBS was a prospective randomised controlled trial nested within the CRASH-2 trial. Randomisation was balanced by centre, with an allocation sequence based on a block size of eight. We used a local pack system that selected the lowest numbered treatment pack from a box containing eight numbered packs. Apart from the pack number, the treatment packs were identical. The pack number was recorded on the entry form, which was sent to the international trial co-ordinating centre in London, UK. Once the treatment pack number was recorded, the patient was included in the trial whether or not the treatment pack was opened or the allocated treatment started. All site investigators and trial co-ordinating centre staff were masked to treatment allocation. Ten hospitals: (India) Aditya Neuroscience Centre, Sanjivani Hospital, CARE Hospital, Christian Medical College, Medical Trust Hospital, Jeevan Jyoti Hospital and (Colombia) Hospital Universitario San Vicente de Paul, Hospital Pablo Tobón Uribe, Hospital Universitario San José de Popayán and Fundación Valle del Lili. The trial was conducted in a subset of 270 CRASH-2 trial participants. Patients eligible for inclusion in the CRASH-2 IBS fulfilled the inclusion criteria for the CRASH-2 trial, and also had TBI [Glasgow Coma Scale score of ≤ 14 and a brain computerised tomography (CT) scan compatible with TBI]. Pregnant women and patients for whom a second brain CT scan was not possible were excluded. Participants were randomly allocated to receive either a loading dose of 1 g of TXA infused over 10 minutes followed by an intravenous infusion of 1 g over 8 hours or matching placebo. The primary outcome was the increase in size of intracranial haemorrhage growth between a CT scan at hospital admission and a second scan 24-48 hours later. One hundred and thirty-three patients were allocated to TXA and 137 to placebo, of whom information on the primary (imaging) outcome was available for 123 (92%) and 126 (92%) respectively. The analysis suggested that TXA was likely to be associated with a reduction in haemorrhage growth [adjusted difference -3.8 ml, 95% credibility interval (CrI) -11.5 ml to 3.9 ml], fewer focal ischaemic lesions [adjusted odds ratio (OR) 0.54, 95% CrI 0.20 to 1.46] and fewer deaths (adjusted OR 0.49, 95% CrI 0.22 to 1.06). This was the first randomised controlled study to evaluate the effect of TXA in TBI patients and it found that neither moderate benefits nor moderate harmful effects can be excluded. However, although uncertainty remains, our analyses suggest that TXA administration might improve outcome in TBI patients and provide grounds for evaluating this hypothesis in future research. Current Controlled Trials ISRCTN86750102. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 16, No. 13. See the HTA programme website for further project information.

The challenges of meeting the blood transfusion requirements in Sub-Saharan Africa: the need for the development of alternatives to allogenic blood.

As a resource, allogenic blood has never been more in demand than it is today. Escalating elective surgery, shortages arising from a fall in supply, a lack of national blood transfusion services, policies, appropriate infrastructure, trained personnel, and financial resources to support the running of a voluntary nonremunerated donor transfusion service, and old and emerging threats of transfusion-transmitted infection, have all conspired to ensure that allogenic blood remains very much a vital but limited asset to healthcare delivery particularly in Sub-Saharan Africa. This is further aggravated by the predominance of family replacement and commercially remunerated blood donors, rather than regular benevolent, nonremunerated donors who give blood out of altruism. The demand for blood transfusion is high in Sub-Saharan Africa because of the high prevalence of anemia especially due to malaria and pregnancy-related complications. All stakeholders in blood transfusion have a significant challenge to apply the best available evidenced-based medical practices to the world-class management of this precious product in a bid to using blood more appropriately. Physicians in Sub-Saharan Africa must always keep in mind that the first and foremost strategy to avoid transfusion of allogenic blood is their thorough understanding of the pathophysiologic mechanisms involved in anemia and coagulopathy, and their thoughtful adherence to the evidenced-based good practices used in the developed world in a bid to potentially reduce the likelihood of allogenic blood transfusion in many patient groups. There is an urgent need to develop innovative ways to recruit and retain voluntary low-risk blood donors. Concerns about adverse effects of allogenic blood transfusion should prompt a review of transfusion practices and justify the need to search for transfusion alternatives to decrease or avoid the use of allogenic blood. These strategies should include the correction of anemia using pharmacological measures (use of antifibrinolytics to prevent bleeding and the use of erythropoietin and oral and intravenous iron to treat anemia) use of nonpharmacologic measures (preoperative autologous blood transfusion, perioperative red blood cell salvage and normothermia to reduce blood loss in surgical patients). All these strategies will help optimize the use of the limited blood stocks.

The Use of Recombinant Factor VIIa in Surgical Bleeding in Nonhemophiliac Patients

SUMMARYHemorrhage due to elective or emergency surgery results in significant patient morbidity and mortality and consumption of scarce transfusion resources. Recombinant factor VIIa (rFVIIa) has been proposed as a universal hemostatic agent which may be beneficial in reducing blood loss and in treating unexpected massive hemorrhage in surgical patients. In elective surgery, a small number of randomized studies have shown a limited benefit for rFVIIa in the reduction of transfusion requirements. In massive hemorrhage associated with surgery, two case series and a growing number of case reports suggest that rFVIIa is successful as salvage therapy. However, a number of questions remain regarding the optimal dose, the true rate of thromboembolic complications and the overall survival and cost benefit when rFVIIa is used for this indication. In this review, the role of rFVIIa in managing blood loss in surgical patients is assessed in the light of current evidence.