Blood-saving Techniques Research Articles

Experiences in the use of intraoperative blood-saving techniques and transfusion requirements in cardiovascular surgery: a study in a high complexity center in Bogotá (2019- 2021).

Experiences in the use of intraoperative blood-saving techniques and transfusion requirements in cardiovascular surgery: a study in a high complexity center in Bogotá (2019- 2021).

Benefits of a spine team for the surgical management of paediatric scoliosis

BackgroundFor many years, blood-saving techniques and the enhanced recovery after surgery approach have been used to optimise the quality of care and shorten hospital stays. The creation of dedicated spine teams combining surgeons and anaesthesiologists specialised in spine surgery has been proven beneficial in adults. The objective of this study was to determine whether involving a spine team in the management of paediatric patients with scoliosis treated by posterior spinal fusion was associated with shorter hospital stays. HypothesisThe hospital stay would be shorter in patients managed by a spine team. Materials and methodsThis single-centre, non-randomised, comparative study was initiated after approval by the local ethics committee. One group of patients was managed by a spine team composed of an anaesthesiologist and a surgeon with over 10 years of experience and the control group by an anaesthesiologist and a surgeon with less than 5 years of experience. The primary outcome was hospital stay length (median [interquartile range]). ResultsThe study included 157 paediatric patients who underwent spinal fusion in 2021 for adolescent idiopathic scoliosis (AIS, n = 106) or secondary scoliosis (n = 51). The spinal team was involved for 48 (45%) AIS procedures and 38 (74.5%) secondary-scoliosis procedures. Both operative time and anaesthesia time were significantly shorter in the spinal-team group, by 10% and 15% (p < 0.001 for both comparisons), respectively, for SIA and by 20% (p = 0.002) and 25% (p < 0.001), respectively, for secondary scoliosis. The spinal-team group had a shorter median hospital stay, the difference being significant for AIS (in days, 5 [4–7] versus 7.1 [5–10], p = 0.03) and nearly significant for secondary scoliosis (6.9 [5–10] versus 9 [6–23], p = 0.07). Fewer patients required blood transfusion in the spine-team group than in the control group (AIS: 0% versus 8.8%, p = 0.05; and secondary scoliosis, 28% versus 58%, p<0.01). ConclusionInvolvement of a spine team optimises the peri-operative management of patients with AIS, thus shortening the hospital stay. Further work is needed to assess the potential associations of spine team involvement with complication rates. Level of evidenceIII; non-randomised comparative study.

Clinical benefits of parenteral iron carboxymaltose in patients with colorectal cancer: a retrospective observational study

Background. The high incidence of anemia in colorectal cancer and its severe consequences for patients determine the need for timely diagnosis and correction of this condition. At the same time, it is extremely important to choose a method for correcting anemia, allowing to achieve maximum efficiency and safety. Aim. To evaluate perioperative methods for correcting iron deficiency anemia in patients with colorectal cancer based on a comparative analysis of the clinical results of intravenous administration of iron carboxymaltose and transfusion of blood components. Materials and methods. The results of treatment of 594 patients with colorectal cancer operated on in 2022 at the department of surgical treatment methods No. 3 (abdominal oncology No. 1) of the Volgograd Regional Clinical Oncology Dispensary were studied. Stratification of patients into groups was carried out using the method of pseudo-randomization by sex and age to eliminate confounding errors. After pseudo-randomization in a 1:1 ratio, the sample of patients with anemia was divided into 2 groups (main group – 124 patients, in whose treatment blood-saving techniques and parenteral administration of iron carboxymaltose were used, and control group – 124 patients, for treatment of anemia in which transfusions of blood components were used). In 98 (39.5%) cases hemicolectomies were performed, in 88 (35.5%) – anterior resections of the rectum, in 36 (14.5%) – resections of the sigmoid colon, in 18 (7.3%) – extirpations of the rectum, in 8 (3.2%) – resection of the transverse colon, 217 (87.5%) operations were performed through laparotomy access, 31 (12.5%) using minimally invasive technologies. Results. The frequency of postoperative complications of grade III–V according to Clavien–Dindo score in the main group (4.8%, 6/124) was statistically significantly lower compared to the control group (14.5%, 18/124) [χ2=6.643; p=0.01]. Postoperative mortality in the main group was 0.8% (1/124), in the control group – 5.6% (7/124) [χ2=4.65; p=0.032]. Conclusion. The use of blood-saving technologies with parenteral administration of iron carboxymaltose in patients with colorectal cancer leads to a reduction in the number of postoperative complications and the level of postoperative mortality.

A pre-operative scoring model to estimate the risk of blood transfusion over an ovarian cancer debulking surgery (BLOODS score): a Memorial Sloan Kettering Cancer Center Team Ovary study

ObjectivesTo develop a pre-operative tool to estimate the risk of peri-operative packed red blood cell transfusion in primary debulking surgery.MethodsWe retrospectively reviewed an institutional database to identify patients who underwent...

Factors that influence blood loss requiring transfusion in total elbow arthroplasty: a retrospective study using ACS-NSQIP database

BackgroundBlood loss requiring transfusion is common in orthopedic surgeries. This study aims to identify modifiable factors associated with higher blood loss requiring transfusion in total elbow arthroplasty (TEA). MethodsData from the American College of Surgeons National Surgical Quality Improvement Program’s database was analyzed. Patients who underwent primary TEA from 2006 to 2021 were categorized based on blood loss requiring transfusion. Preoperative variables and comorbidities were compared using a multivariate regression to determine odds ratios (ORs). ResultsOut of 654 patients, 30 (4.6%) experienced blood loss requiring transfusion following TEA. On multivariate logistic regression, the following variables were significant: low preoperative hematocrit (<36% in females, <41% in males) (OR 18.2, P < .01), inpatient location (OR 15.3, P < .01), elevated preoperative creatinine (>1.3 mg/dL) (OR 5.7, P < .01), active smoking (OR 2.2, P = .01), chronic obstructive pulmonary disease (OR 2.1, P = .02), and low white blood cell count (<4.5 × 109/L) (OR 1.9, P = .03), and body mass index (OR 0.9, P < .01). ConclusionThe overall rate of blood loss requiring transfusion in TEA was 4.6%. Identifying preoperative risk factors is crucial to minimize transfusion risk. Optimizing patient lab values may help reduce transfusion rates. Blood-saving techniques and antifibrinolytic agents like tranexamic acid should be considered for patients at increased risk of transfusion.

New method for determining volume of intraoperative blood loss during burn treatment surgery

BACKGROUND: Nowadays, there are numerous ways to assess the volume and minimize intraoperative blood loss; however, their effectiveness is subjective. To compare the effectiveness of blood-saving techniques, it is necessary to create new more reliable methods for determining intraoperative blood loss.&#x0D; AIM: To develop a new technique for determining intraoperative blood loss in the surgical treatment of burn victims.&#x0D; MATERIALS AND METHODS: In the course of the study, we have developed and proposed our own, original method for determining the volume of intraoperative blood loss, taking into account the indicators of hemoglobin and hematocrit as well as a differentiated calculation of the volume of circulating blood. This technique has been tested on 82 victims with deep burns of the II–III degree (International Classification of Diseases 10th Revision), who were admitted to the department of thermal lesions in the period from April 2021 to December 2021. The data obtained have been processed in the Microsoft Excel 2007 program as well as by generally accepted methods of nonparametric statistics.&#x0D; RESULTS: The methods currently available have a large variability of results when performing the same intervention. The developed technique shows a stable relationship between the volume of blood loss and the area of the excised scab.&#x0D; CONCLUSIONS: The data obtained allow to conclude that the new method for determining blood loss in burn victims appears to be a simple and effective method. The new technique will allow to find the most effective methods of minimizing blood loss during surgical necrectomies, which will reduce the need for additional hemotransfusions and promote earlier rehabilitation of burn treatment.

On the Issue of Optimizing Surgical Tactics and Blood-Saving Techniques in Case of Placenta Ingrowth Into the Uterine Scar

AIM OF STUDY The study of the results of delivery of pregnant women with placenta ingrowth in the uterine scar depending on the clinical status and the methods of blood saving.MATERIAL AND METHODS The design of a selective retrospective study included 54 pregnant women with central placenta previa and uterine scar after caesarean section (CS), with histologically confirmed results of placenta accreta. Among blood-saving methods we used: ligation of three pairs of main vessels of the uterus, ligation of the internal iliac arteries, complex compression hemostasis according to R.G. Shmakov, temporary clamping of the common iliac arteries.RESULTS CS with fundal incision was performed in 47 women (87.0%) out of 54. Hysterectomy was performed in 17 women (31.5%) out of 54. In the remaining 37 cases (68.5%), metroplasty and organ preservation were performed. There was no relaparotomy; there was no maternal mortality; perinatal mortality was 4 (7.4%); forced opening, bladder resection were performed in 7 (13.0%) cases; opening of the bladder without wall resection — in 2 (3.7%); 2 near miss cases; there were no complications associated with temporary clamping of the common iliac arteries; endometritis (recovery after conservative treatment) was revealed in 2 women (3.7%). Histologic examination results: 15 (27.8%) of placenta accreta, 30 (55.6%) of placenta increta, 8 (14.8%) of placenta percreta. In 8 cases, there was a combination of placenta increta into the uterine scar region of different depths, and in 2 (3.7%) cases, a combined deeply invasive lesion of the posterior wall of the lower segment and the body of the uterus.CONCLUSION Complex compression hemostasis according to R.G. Shmakov is the most rational and promising method of blood saving, acceptable among the majority of patients with placenta accreta spectrum. Temporary clamping of the common iliac arteries is advisable in case of damage to the posterior wall of the bladder. Preservation of the uterus: in case of a deeply invasive lesion, including cases of combined damage to the posterior wall of the lower segment of the uterus or the body of the uterus, significant blood loss before the woman enters the hospital, it is not an imperative of surgical tactics.

A preoperative tool for estimating the risk of blood transfusion over an ovarian cancer debulking surgery (113)

<b>Objectives:</b> To develop a preoperative tool for estimating the risk for packed red blood cell transfusion during primary debulking surgery (PDS) for ovarian cancer and in the postoperative setting. This will help physicians identify a subgroup of patients that will benefit from surgical planning and blood-saving techniques. <b>Methods:</b> We conducted a single-center ovarian cancer database review of women undergoing PDS between 2001-2019. Exclusion criteria included patients with preoperative hemoglobin <10.0g/dl. Associations between the criteria and PDS outcomes were tested using the Wilcoxon Rank-Sum test for continuous variables and Fisher's exact test for categorical variables. A receiver operating characteristics (ROC) curve was generated to build a model predictive of transfusion; AUC was used as a measure of predictive accuracy. A multivariable regression model was developed to evaluate the odds of transfusion. These criteria were then assigned a risk of transfusion—a "BLood transfusion Over an Ovarian cancer Debulking Surgery (BLOODS)" score—according to their multivariate odds ratios (ORs). The total score of all patients in the cohort was subsequently calculated, and the odds of receiving a transfusion corresponding to each total score were determined. <b>Results:</b> A total of 1289 patients met the eligibility criteria. Median estimated blood loss was 650cc (range: 10-8150cc), with 375 patients experiencing a blood loss ≥1000cc (29%). A total of 1087 (84%) underwent optimal PDS (≤1cm of residual disease), 654 (51%) had complete gross resection. The presence of upper abdominal disease ≥1cm was most heavily associated with the need for transfusion intraoperatively and/or postoperatively (OR: 3.11, 95% CI: 2.47-3.91), followed Table by the presence of ascites (OR: 3.07, 2.44-3.87), albumin ≤3.5 (OR: 2.51, 1.76-3.59), carcinomatosis (OR: 2.27, 1.76-2.93), and CA-125 ≥600 (OR: 2.46, 1.95-3.10). On multivariable analysis, seven criteria were associated with blood transfusion: ASA ≥3 (1.05, 1.00-1.10), albumin ≤3.5 (1.26, 1.19-1.34), ascites (1.06, 0.98-1.15), CA-125 ≥600 (OR: 1.10, 1.04-1.16), carcinomatosis (1.01, 0.93-1.10), creatinine >0.90 (1.14, 1.07-1.22), upper abdominal disease ≥1cm (1.16, 1.07-1.25). A predictive (BLOODS) score was assigned to each of the seven criteria based on their multivariable ORs. A BLOODS score of ≥3 is projected to identify a rate of 85% of primary ovarian cancer cytoreductive cases requiring an intraoperative blood transfusion, 78% requiring a postoperative blood transfusion, and 80% overall. <b>Conclusions:</b> The BLOODS score can be used as a universal preoperative scoring system for patients with ovarian cancer undergoing PDS. The model estimates the risk of requiring a blood transfusion, which is directly proportional to ASA, albumin, ascites, CA-125, carcinomatosis, creatinine, and the presence of upper abdominal disease. This will help physicians with surgical planning and can benefit patient outcomes.

Acute normovolemic hemodilution as an alternative to hardware-assisted blood-saving techniques in operations for the correction of spinal deformities in patients with grade III-IV scoliosis

There were 45 adolescent patients with scoliosis of III-IV degree who underwent operative correction of the spine deformity by Cotrel-Dubousset system. Intraoperatively 26 patients received autologous shed blood reinfusion collected from wound drainage (mean 17.3+5.6 ml/kg), no donor erythrocytic mass was transfused. In 19 patients presurgical normovolemic hemodilution with 500 ml blood donation was performed. Reinfusion of that blood as well as the transfusion of donor washed off erythrocytes (mean 13.8+1.3 ml/kg) were performed at the peak of blood loss. Marked differences in patients condition were noted neither during surgical intervention nor in the postoperative period. It was concluded that normovolemic hemodilution in combination with transfusion of donor washed off erythrocytes may be the alternative to reinfusion of autologous shed blood if the later could not be performed.

Cardiac Surgery and Blood-Saving Techniques: An Update.

Cardiac surgery is typically attributed with a significant risk of intraoperative blood loss and allogeneic blood transfusions. Intraoperative blood loss, allogenic blood transfusions, high dose anticoagulation requirement, and interactions with cardiopulmonary bypass (CPB) have all been linked to cardiac surgeries. To reduce unnecessary transfusions and their negative effects, it is recommended to follow evidence-based multidisciplinary strategies, which are collectively termed patient blood management (PBM). This review highlights the most recent blood conservation strategies in adult cardiac surgery, which can be employed pre-operatively, intra-operatively, and postoperatively, to enhance red cell mass and attenuate the utilization of packed red blood cells (PRBCs) and other blood products.

Периоперационное внедрение кровосберегающих технологий в интенсивной терапии больных онкопроктологического профиля

Мировая тенденция относительно использования кровезамещающих методик при оперативных вмешательствах, сопровождающихся значительной кровопотерей, вполне обоснованно приобретает все большую популярность. Известно множество осложнений, связанных с проведением переливания крови и ее компонентов. Однако, не имея на замену в своем арсенале альтернативных «бескровных» методик периоперационного мене­джмента, провести многие операции просто невозможно. В данной работе проведен анализ клинико-лабораторных показателей у пациентов с использованием стимуляторов эритропоэза в периоперационном менеджменте радикальных онкопроктологических операций по сравнению со стандартным ведением больных с использованием гемотрансфузии.

The Impact of Complex Preoperative Preparation of Patients with Aortic Heart Diseases on the Level of Postoperative Anemia

In patients undergoing surgical treatment of aortic heart defects under artificial circulation, pre-operative correction of serum iron levels, and application of blood-saving techniques during surgery reduce the level of postoperative anemia. The aim. To investigate the combined influence of preoperative correction of serum iron levels and blood-saving techniques in the early postoperative anemia in the surgical treatment of aortic heart defects under artificial circulation. Material and methods. This study involves 133 patients with acquired aortic heart diseases undergoing surgical treatment under artificial circulation and aims at identifying the combined effect of preoperative correction of serum iron (III) hydroxide levels and blood-saving techniques on the level of postoperative anemia. The levels of iron, transport enzymes, blood corpuscles, Hb and Ht were investigated. All the patients were divided into 3 groups. Group A (control group) included 52 patients in whom iron levels were within the normal range and donated blood components were used during the intervention. Group B (study group) included 43 patients in whom iron levels were within the normal range and blood-saving techniques were used during the intervention. Group C (adjustment group) included 38 patients with low iron levels and anemia, which was interpreted as anemia of chronic disease (ACD). Preoperative correction of serum iron levels and intraoperative blood-saving techniques were applied in this group. Results. For the purpose of perioperative anemia correction, transfusion of 539.8 ± 9.1 ml (p¤0.05) of packed red blood cells and 582.4 ± 77.2 ml (p¤0.05) of fresh frozen plasma was given in Group A patients. In the Group B, the use of blood-saving techniques during the intervention allowed us to obtain good clinical effect without perioperative transfusion of blood products. It was established that in Group C preoperative correction of serum iron enabled to achieve 5.6 times higher level of serum iron (p¤0.05), 2 times higher transferrin saturation, and 7.3 times higher ferritin activity (p¤0.05), as well as increase preoperative Hb level by 9.5 % and decrease postoperative anemia by 8.7 %. Conclusions. Correction of low baseline serum iron in patients with chronic anemia (ACD) provides 5.6 times increase in preoperative serum iron (SI) (p¤0.05), increases hemoglobin by 9.5% (p¤0.05), and reduces the level of postoperative anemia in patients undergoing surgical treatment of aortic heart defects under artificial circulation with the use of blood-saving techniques and without the use of donor blood and Cell Saver.

Predicting lowest hemoglobin level and risk of blood transfusion in spinal fusion surgery for adolescent idiopathic scoliosis.

The aim of this study was to evaluate the factors associated with timing of lowest hemoglobin (Hb) level and the need for postoperative blood transfusion in posterior spinal fusion for adolescent idiopathic scoliosis. We conducted a retrospective review of all adolescent scoliosis patients undergoing posterior spinal fusion at our institution, 2002-2014. Surgery consisted of segmental pedicle screw fixation using multi-level pedicle screws. Blood-saving techniques were used in all patients. Data included Cobb angle, pre- and postoperative Hb levels, preoperative autologous blood donation (PABD), surgery duration, and allogeneic or autologous transfusion. We used linear and logistic regressions for statistical analysis. There were 456 patients (402 female, 54 male), mean age 16 ± 5years. Lowest Hb was observed on postoperative Days 2 (32.2%) and 3 (33.3%); 45.1% of postoperative transfusions occurred on Day 2. One hundred and eighty-eight (41%) patients who provided PABD had significantly lower preoperative Hb and received more transfusions intraoperatively (22.6% vs. 5.2%) and postoperatively (20% vs. 6.3%) than others. Probability of transfusion increased 49.6 (95% CI 17.40-141.37) times with preoperative Hb < 11g/dL as compared to preoperative Hb > 14g/dL. Probability of transfusion increased 4.3- and 9.8-fold when surgery duration exceeded 5 and 6h, respectively. Probability of transfusion increased 3.3- and 5.3-fold with Cobb angle > 70° and 80°, respectively. We identified clear patient-specific perioperative parameters that affect risk of perioperative blood transfusion, including Cobb angle, PABD and preoperative Hb. Hb measurement beyond postoperative Day 3 is considered unnecessary unless clinically indicated. These slides can be retrieved under Electronic Supplementary Material.

Blood management in total hip replacement: an analysis of factors associated with allogenic blood transfusion.

The aim of this study was to audit the blood transfusion practice throughout the Epworth Healthcare Hospitals for patients undergoing primary total hip replacement (THR). We determined if blood-saving techniques were having an impact on the risk of allogenic blood transfusion and which patients were at risk of receiving allogenic blood transfusion. This study uses a retrospective audit of 787 patients who had undergone primary THR surgery at three Melbourne hospitals: Epworth Richmond, Epworth Eastern and Epworth Freemasons in 2010. Patient demographics, transfusion requirements and blood-conserving techniques were recorded. One hundred and eighty (23%) patients received allogenic blood transfusion and 18 (2.3%) patients received autologous blood transfusion. On multivariate analysis, preoperative anaemia (odds ratio (OR) 4.7, P < 0.0001), female gender (OR 3.1, P < 0.0001) and patient age (OR 1.07 per year of age increase, P < 0.0001) were shown to be significantly associated with higher risk of allogenic blood transfusion. Use of spinal anaesthetic was found to be associated with lower risk of transfusion (OR 0.6, P = 0.0180) compared with general anaesthetic alone. Cell saver, acute normovolaemic haemodilution and re-infusion drain tube usage did not have a significant impact on reducing the risk of allogenic blood transfusion. Identification of patients at risk of blood transfusion, correction of preoperative anaemia and a restrictive transfusion policy are important factors to consider in effective perioperative blood management.

Blood management of staged bilateral total knee arthroplasty in a single hospitalization period.

IntroductionFew literatures have studied the blood management in patients treated with staged bilateral primary total knee arthroplasty (TKA) in a single hospitalization period. Therefore, this study aims to evaluate the effectiveness and safety of the newly introduced multimodal blood management (MBM) in these patients.Materials and methodsWe retrospectively compared the perioperative parameters in 70 cases undergoing staged bilateral primary TKA in a single hospitalization period from 2012–2013 in a single center with two different groups of patients, allocating cases to the group with the newly introduced MBM (Group A, n =33) and controls to the group without the newly introduced MBM (Group B, n =37). The newly introduced MBM protocols include preoperative hemoglobin (Hb) evaluation, high protein diet, tourniquet release after skin closure, preoperative oral iron treatment and femoral canal obturation, and one dose of tranexamic acid (TXA) IV with another one if necessary. While in the control group, only routine blood-saving techniques were used.ResultsGroup A had a transfusion rate of 9% (3/33), whereas 32.4% of patients (12/37) in Group B received allogenic blood transfusion. Significant benefits were also found in Group A in terms of postoperative Hb and hematocrit (Hct), reduction of postoperative pain, swelling, postoperative pain, length of stays, and hospital costs. No deep vein thrombosis (DVT) events were found in all these patients.ConclusionsThe newly introduced MBM in staged bilateral TKA in a single hospitalization period can reduce blood loss effectively as well as pain and knee joint swelling instead of leading to increased complications and result in significant cost savings.

The pattern of blood loss in adolescent idiopathic scoliosis

Background contextPrevious studies have shown that modern intraoperative blood-saving techniques dramatically reduce the allogeneic transfusion requirements in surgery for adolescent idiopathic scoliosis (AIS). No studies have looked at the pattern of postoperative hemoglobin (Hb) in AIS patients undergoing corrective spinal surgery and correlated this with the timing of allogeneic transfusion. PurposeTo describe the pattern of perioperative blood loss in instrumented surgery for AIS. We look at the recommendations regarding an ideal preoperative Hb, the need for preoperative cross-matching, and the timing of postoperative Hb analysis. Study designThis was a retrospective case series. Surgeries were performed by one of four substantive pediatric spinal surgeons within a single regional center over a 3-year period. Patient sampleA consecutive series of 86 patients who underwent posterior instrumented fusion for AIS were included: 10 males and 76 females. Mean age was 14 years (range 10–17 years). All patients had posterior instrumented fusion using various blood-saving techniques (eg, cell-saver). All patients were cross-matched preoperatively, and our transfusion trigger value (TTV) was 7 g/dL. Outcome measuresHemoglobin level was the outcome measure. Hemoglobin readings were obtained preoperatively, within 2 hours of surgery, and daily up to 5 days after surgery. This physiologic measure was assessed using routine blood sampling techniques and standardized laboratory processing. MethodsPatient predictor variables (demographic and surgical) were assessed for association with Hb levels in a hierarchical model, with repeated Hb readings at the lower level being clustered within an individual patient at the upper level of the structure. The variation of Hb levels within individuals was compared with mean levels in different individuals via the variance partition coefficient of the model structure. ResultsNo patients required intraoperative allogeneic transfusion. Only four patients (4.65%) received allogeneic transfusion, all within 2 days of surgery. A clinically important drop in Hb occurred within the first 2 postoperative days, rising thereafter. The average postoperative drop in Hb was 4.1 g/dL. Young males had lower postoperative Hb values. Neither the preoperative curve magnitude (Cobb angle of major curve) nor the number of vertebrae/levels fused significantly affected the blood loss. ConclusionsWe recommend setting a minimum preoperative Hb value that is 5 g/dL higher than your TTV. Because no patients required an intraoperative transfusion when using modern blood-saving techniques, preoperative cross-matching is unnecessary and potentially wasteful of blood reserves. Hemoglobin analysis beyond the second postoperative day is unnecessary unless clinically indicated.

Patient blood management in orthopaedic surgery: a four-year follow-up of transfusion requirements and blood loss from 2008 to 2011 at the Balgrist University Hospital in Zurich, Switzerland.

The aim of this study was to investigate the impact of the introduction of a Patient Blood Management (PBM) programme in elective orthopaedic surgery on immediate pre-operative anaemia, red blood cell (RBC) mass loss, and transfusion. Orthopaedic operations (hip, n=3,062; knee, n=2,953; and spine, n=2,856) performed between 2008 and 2011 were analysed. Period 1 (2008), was before the introduction of the PBM programme and period 2 (2009 to 2011) the time after its introduction. Immediate pre-operative anaemia, RBC mass loss, and transfusion rates in the two periods were compared. In hip surgery, the percentage of patients with immediate pre-operative anaemia decreased from 17.6% to 12.9% (p<0.001) and RBC mass loss was unchanged, being 626±434 vs 635±450 mL (p=0.974). Transfusion rate was significantly reduced from 21.8% to 15.7% (p<0.001). The number of RBC units transfused remained unchanged (p=0.761). In knee surgery the prevalence of immediate pre-operative anaemia decreased from 15.5% to 7.8% (p<0.001) and RBC mass loss reduced from 573±355 to 476±365 mL (p<0.001). The transfusion rate dropped from 19.3% to 4.9% (p<0.001). RBC transfusions decreased from 0.53±1.27 to 0.16±0.90 units (p<0.001). In spine surgery the prevalence of immediate pre-operative anaemia remained unchanged (p=0.113), RBC mass loss dropped from 551±421 to 404±337 mL (p<0.001), the transfusion rate was reduced from 18.6 to 8.6% (p<0.001) and RBC transfusions decreased from 0.66±1.80 to 0.22±0.89 units (p=0.008). Detection and treatment of pre-operative anaemia, meticulous surgical technique, optimal surgical blood-saving techniques, and standardised transfusion triggers in the context of PBM programme resulted in a lower incidence of immediate pre-operative anaemia, reduction in RBC mass loss, and a lower transfusion rate.

Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach

Our aim was to clarify the effective decrease in blood transfusion after primary total knee arthroplasty (TKA) from a multimodal blood-loss prevention approach (MBLPA) and the related risk factors of blood transfusion. We retrospectively compared the rate of postoperative blood transfusion in 418 cases of primary TKA during 2010 from a single institution with two different groups of patients, allocating cases to the group with MBLPA (group 1, study group, N = 71) and controls to the group without MBLPA (group 2, standard group, N = 347). MBLPA procedure included pre-operative haemoglobin (Hb) optimisation; femoral canal obturation; limited incision and release; peri- and intra-articular use of saline with adrenalin, morpheic chloride, tobramycin, betamethasone and ropivacaine; tourniquet release after skin closure; 24 hour drain under atmospheric pressure; and two doses of tranexamic acid (TXA) i.v.. In the control group, surgeons followed the standard procedure without blood-saving techniques. Case-control comparison and blood transfusion risk factors were analysed. Group 1 had a zero transfusion rate (0/71), whereas 27.4% of patients (95/347) in group 2 received allogenic blood transfusion. Significant transfusion risk factors were pre-operative Hb <12 g/dl), American Society of Anesthesiologists (ASA) status III and nonobese body mass index (BMI); Age and gender were not significant risk factors. MBLPA in primary TKA was highly effective, with a zero transfusion rate. Risk factors for transfusion were determined, and eliminating them contributed to the avoidance of allogeneic blood transfusion in our study series.

El tratamiento preoperatorio con aspirina a dosis bajas no aumenta la hemorragia quirúrgica ni la tasa transfusional en la prótesis total de rodilla

ObjectivesSurgical bleeding. transfusion rate and cardiovascular complications were analized in patients undergoing chronic treatment with low-doses aspirin and scheduled to unilateral primary knee arthroplasty. Patients and methodsWe retrospectively studied 117 patients between 2005 and 2006 scheduled for elective knee replacement that received antiplatelet therapy with aspirin (100mg/day). Aspirin medication was maintained or discontinued preoperatively according to medical criteria. We analyzed the biological, clinical and anesthetic data, blood-saving techniques used, surgical bleeding, allogeneic blood transfusion rate, cardiocirculatory complications (myocardial, cerebral or peripheral ischemia), hospital stay and mortality. This population was compared with 190 patients (control group) who underwent the same operation at the same time interval but did not receive aspirin therapy. ResultsThe aspirin-treated group was significantly older, with higher weight and poorer health state (higher incidence of ischemic heart disease, cerebral ischemia and diabetes). The hidden and external surgical bleeding and transfusion rate were similar if the aspirin were interrupted or not, preoperatively. Bleeding and transfusion rates were independent of time of interruption of the aspirin. Hospital mortality was zero in the 2 groups. A acute myocardial infarction and a transient stroke happened in two patients wich aspirin treatment was discontinued. ConclusionsPreoperative treatment with low doses of aspirin does not increase surgical bleeding and transfusion rate in total knee arthroplasty. Preoperative discontinuation can cause severe cardiocirculatory complications.

Perioperative problems and treatment of a teenager with a juvenile angiofibroma refusing blood transfusion

Objectives Juvenile angiofibroma is a benign, non-encapsulated neoplasm, consisting of vascular and connective tissue. Its main feature is a local malignancy. In its clinical course it destroys adjoining structures, without metastasizing. It appears rarely, and is mainly found in boys at puberty. Among theories about the aetiology of juvenile angiofibroma, we must consider a haematoma-like lesion, an angioma with an extended fibrous component, or type of inflammatory allergic polyp. In the development of the lesion the participation of hormonal disorders on the pituitary gland-gonad axis is also suggested. According to the latest research, juvenile angiofibroma is regarded as a developmental defect, affecting the embryonic vascular network surrounding the sphenoid bone. Methods If the patient or his/her parents refuse blood transfusion and use of blood products, it is necessary to apply modifications in the routine perioperative treatment. In the case of the patient refusing blood and blood products transfusion because of their beliefs, it is possible to get consent to use different, highly processed products like albumins or a cryoprecipitate, as well as applying some blood-saving techniques. Conclusions 1. Removal of juvenile angiofibroma with minimal bleeding is possible. 2. Applying erythropoietin and iron preparations prior to surgery increases erythropoiesis and reduces the risks in transfusion. 3. Applying intraoperative normovolaemic haemodilution is a safe method and allows avoidance of transfusion of blood-derived products.