Reinfusion Of Blood Research Articles

Intraoperative cell salvage with autologous transfusion in liver transplantation.

Liver transplant (LT) is the primary treatment for patients with end-stage liver disease. About 25000 LTs are performed annually in the world. The potential for intraoperative bleeding is quite variable. However, massive bleeding is common and requires blood transfusion. Allogeneic blood transfusion has an immunosuppressive effect and an impact on recipient survival, in addition to the risk of transmission of viral infections and transfusion errors, among others. Techniques to prevent excessive bleeding or to use autologous blood have been proposed to minimize the negative effects of allogeneic blood transfusion. Intraoperative reinfusion of autologous blood is possible through previous self-donation or blood collected during the operation. However, LT does not normally allow autologous transfusion by prior self-donation. Hence, using autologous blood collected intraoperatively is the most feasible option. The use of intraoperative blood salvage autotransfusion (IBSA) minimizes the perioperative use of allogeneic blood, preventing negative transfusion effects without negatively impacting other clinical outcomes. The use of IBSA in patients with cancer is still a matter of debate due to the theoretical risk of reinfusion of tumor cells. However, studies have demonstrated the safety of IBSA in several surgical procedures, including LT for hepatocellular carcinoma. Considering the literature available to date, we can state that IBSA should be routinely used in LT, both in patients with cancer and in patients with benign diseases.

Ultrafiltration and reinfusion of residual cardiopulmonary bypass pump blood: A prospective non-randomized controlled study.

The aim of the study was to investigate whether processing residual pump blood with ultrafiltration could increase the increment of hemoglobin after residual pump blood reinfusion and evaluate its influence on plasma-free hemoglobin (pFHb) level and postoperative renal function. Sixty adult patients undergoing elective cardiac surgery with cardiopulmonary bypass were assigned to 2 groups, based on pump blood processing strategy: ultrafiltration plus reinfusion (n=30) or reinfusion (control; n=30). Increment in hemoglobin and pFHb after reinfusion (ΔHgb, ΔpFHb), reinfusion volume, postoperative chest drainage volume (first 24h), duration of mechanical ventilation, changes in serum creatinine, and prevalence of AKI were compared between the 2 groups. Higher levels of both ΔHgb and ΔpFHb were observed after reinfusion in the ultrafiltration group [ΔHgb 1.8±1.1g/dL vs. 1.2±0.6g/dL, P=0.03, ΔpFHb 100 (0, 200) mg/L vs. 0 (-100, 0) mg/L, P=0.03]. The reinfusion volume was lower in the ultrafiltration group [550 (325, 615) mL vs. 1000 (900, 1180) mL, P<0.001]. No differences were found in postoperative chest drainage volume (first 24h), duration of mechanical ventilation, changes in serum creatinine, and prevalence of AKI. Compared to the unprocessed group, ultrafiltration before reinfusion of residual pump blood improved the hemoglobin level and reduced volume loading. Despite an increase in pFHb, the processing procedure was not related to postoperative kidney injury.

Blood reinfusion in surgery. State of art. Review

This article is analysis of state of the art «blood reinfusion» in surgical patients, based on literature analysis and self-experience. Main topics are indication and contraindication, modern cell-savers, possible complications and utilization of blood reinfusion in different fields of surgery.

The Dual Neuroprotective-Neurotoxic Effects of Sevoflurane After Hemorrhagic Shock Injury

BackgroundThe neuroprotection and neurotoxicity induced by sevoflurane have been gradually established. Choosing anesthetic agents after hemorrhage shock and resuscitation (HSR) induced by bleeding can be challenging. We determined the dual neuroprotective-neurotoxic effects of sevoflurane postconditioning after HSR injury using a model of blood loss and reinfusion in rats via the heme oxygenase-1 (HO-1)/reactive oxygen species (ROS) signal pathway. MethodsThe rats were exposed to 2%-4% sevoflurane postconditioning in vivo after HSR. Learning ability was assessed 30 d after HSR by Morris water maze tests. Hippocampal apoptosis was assessed 7 d after HSR by TdT-mediated dUTP nick-end labeling combined with cleaved caspase-3 (17 kDa). The ROS, mitochondrial membrane potential (MMP), HO-1 expression, and HO activity 1 d after HSR were assessed by fluorometric, JC-1, Western blot, and bilirubin assays, respectively. ResultsCompared with HSR alone, 2% sevoflurane postconditioning improved latency and increased MMP levels, HO-1 expression, and HO activity but decreased TdT-mediated dUTP nick-end labeling-positive cells, cleaved caspase-3 (17 kDa) expression, and ROS production. Pretreatment with hemin, an HO-1 agonist, reversed these effects. Compared with 2% sevoflurane postconditioning plus HSR, slower latency; decreased MMP levels; and increased TdT-mediated dUTP nick-end labeling-positive cells, cleaved caspase-3 (17 kDa), HO-1 expression, HO activity, and ROS production were shown in HSR plus 4% sevoflurane postconditioning, whereas Tin-mesoporphyrin, an HO-1 inhibitor, partially reversed the neurodegeneration of 4% sevoflurane postconditioning. ConclusionThe dual neuroprotective-neurotoxic effects of 2%-4% sevoflurane postconditioning after HSR injury might be associated with increased ROS via the “threshold effect” of HO-1.

Abstract 186: Remote Limb Ischemic Preconditioning Improves Short and Long Term Survival and Maintains Intravascular Blood Volume During Resuscitation of Hemorrhagic Shock

Background: We further examined the protective effects of experimental bilateral lower limb remote ischemic preconditioning (RIPC) in rats undergoing experimental hemorrhagic shock. Methods: Sprague Dawley rats (both genders) were randomized into RIPC (n= 26) or control group (n= 27), and anesthetized with intraperitoneal ketamine/xylazine. RIPC was induced by 4 cycles of inflating small bilateral pressure cuffs to 200 mmHg around the femoral arteries for 5 minutes, followed by 5 minute deflation of the cuffs. Hemorrhagic shock was induced by withdrawing blood from the carotid artery. Target mean blood pressure of 30 mmHg was maintained for 30 minutes followed by reinfusion of shed blood within the next 30 min. Rats remained anesthetized for another 30 min before recovery; endpoints were survival at 72 hours and 6 weeks. Results: The % of estimated total blood volume withdrawn to maintain a level of 30 mmHg was similar in the RIPC group (41.7 ± 1.0 %) and control group (41.9 ± 1.0 %). Recovery of blood pressure during the early resuscitation phase was significantly improved in the RIPC group. The diastolic internal dimension of the left ventricle (echocardiogram), which indicates circulating intravascular blood volume, was significantly larger in the RIPC group at 1 hour after initiation of shed blood reinfusion (5.8 ± 0.1 mm) compared to 5.4 ± 0.1mm in the control group (p=0.04). Left ventricular fractional shortening was comparable between RIPC (50.9 ± 1.9 %) and control group (49.6 ± 1.8 %; p=0.64) at 1 hour after initiation of resuscitation. At 48 hours after shock, BUN was within normal range in the RIPC group (17.3 ± 1.2 mg/dl); but elevated in the control group (22.0 ± 1.7 mg/dl). At 72 hours after hemorrhagic shock injury, 6 of 27 (22.2 %) rats in the control group and 13 of 26 (50 %, p = 0.047) rats in the RIPC group survived. At 6 weeks, 5 of 27 (18.5 %) rats in the control group and 13 of 26 (50 %; p = 0.021) rats in the RIPC group survived. RIPC significantly increased survival rate at both 72 hours and 6 weeks. Conclusions: RIPC improved recovery of blood pressure and maintained more circulating intravascular blood volume in the early phase of resuscitation, improved BUN, and markedly and significantly improved short and long term survival in rats subjected to hemorrhagic shock.

Abstract 187: Effects of Anesthetic Agents on the Hemodynamic Stabilization and Long Term Survival in an Experimental Model of Hemorrhagic Shock

Background: We investigated the cardiovascular responses to acute bleeding and shed blood restoration under different anesthetic agents, and their effects on long-term survival rate after hemorrhagic shock in rats, after our initial pilot study suggested differences between anesthetics. Methods: Sprague Dawley rats (both genders) were randomized to receive either intraperitoneal ketamine/xylazine (K/X, 90 mg/kg and 10 mg/kg; n=12), or isoflurane (5% isoflurane induction and 2% maintenance in room air; n=12) for anesthesia. Blood was withdrawn from the carotid artery to maintain mean arterial blood pressure (MBP) at 30 mm Hg for one hour, followed by 30 min of resuscitation with shed blood. Rats remained anesthetized for another 30 min before they were allowed to recovery and survive for 6 weeks. Hemodynamics were monitored during the surgical procedure. Results: During the shock phase, the total withdrawn blood volume (expressed as % of estimated total blood volume) to maintain MBP at 30 mmHg was significantly higher in the isoflurane group (51 ± 1.5 %) compared to the K/X group (45.3 ± 1.8 %; p=0.023). The diastolic internal dimension of the left ventricle, which indicated circulating intravascular blood volume, was significantly larger in the isoflurane group at the end of 1 hour of the shock phase (4.5 ± 0.2 mm compared to 3.5 ± 0.2 mm in K/X group; p=0.0003) and at 1 hour after initiation of shed blood reinfusion (6.3 ± 0.2 mm compared to 5.3 ± 0.3 in K/X group; p=0.014). Recovery of blood pressure during the resuscitation phase was significantly improved in the isoflurane group compared to the K/X group. The survival rate at 6 weeks was 1 of 12 (8.3%) in rats receiving K/X and 10 of 12 (83.3%) in rats receiving isoflurane (p &lt; 0.001). Histology demonstrated brain infarction in the 1 surviving rat receiving K/X; no brain infarction in the 10 surviving rats that received isoflurane at 6 weeks. No infarction was detected in heart, lung, liver or kidneys in all surviving rats. Conclusions: These results suggest that isoflurane stabilizes the cardiovascular response to acute blood lose and benefits the perfusion of tissue, which resulted in significantly higher long term survival rate and improved blood pressure response to resuscitation, without end-organ infarction.

Analyses of changes in myocardial long non-coding RNA and mRNA profiles after severe hemorrhagic shock and resuscitation via RNA sequencing in a rat model

BackgroundIschemia–reperfusion injury has been proven to induce organ dysfunction and death, although the mechanism is not fully understood. Long non-coding RNAs (lncRNAs) have drawn wide attention with their important roles in the gene expression of some biological processes and diseases, including myocardial ischemia–reperfusion (I/R) injury. In this paper, a total of 26 Sprague–Dawley (SD) rats were randomized into two groups: sham and ischemia–reperfusion (I/R) injury. Hemorrhagic shock was induced by removing 45% of the estimated total blood volume followed by reinfusion of shed blood. High-throughput RNA sequencing was used to analyze differentially expressed (DE) lncRNAs and messenger RNAs (mRNAs) in the heart tissue 4 h after reperfusion. Myocardial function was also evaluated.ResultsAfter resuscitation, the decline of myocardial function of shocked animals, expressed by cardiac output, ejection fraction, and myocardial performance index (MPI), was significant (p < 0.05). DE lncRNAs and mRNAs were identified by absolute value of fold change ≥ 2 and the false discovery rate ≤ 0.001. In rats from the I/R injury group, 851 lncRNAs and 1015 mRNAs were significantly up-regulated while 1533 lncRNAs and 1702 m RNAs were significantly down-regulated when compared to the sham group. Among the DE lncRNAs, we found 12 location-associated with some known apoptosis-related protein-coding genes which were up-regulated or down-regulated accordingly, including STAT3 and Il1r1. Real time PCR assays confirmed that the expression levels of five location-associated lncRNAs (NONRATT006032.2, NONRATT006033.2, NONRATT006034.2, NONRATT006035.2 and NONRATT029969.2) and their location-associated mRNAs (STAT3 and Il1r1) in the rats from the I/R injury group were all significantly up-regulated versus the sham group.ConclusionsThe DE lncRNAs (NONRATT006032.2, NONRATT006033.2, NONRATT006034.2 and NONRATT006035.2) could be compatible with their role in myocardial protection by stimulating their co-located gene (STAT3) after hemorrhagic shock and resuscitation. The final prognosis of I/R injury might be regulated by different genes, which is regarded as a complex network.

Autologous blood reinfusion during iatrogenic acute hemorrhagic cardiac tamponade: Safety and feasibility in a cohort of 30 patients.

Iatrogenic hemorrhagic pericardial tamponade (IHPT) represents a life-threating condition requiring emergency pericardiocentesis. In this clinical context, reinfusion of pericardial blood can stabilize the patient and sustain hemodynamic conditions. We reviewed all cases of IHPT occurred at our hospital over a 10 years span. In all patient autologous blood reinfusion through a femoral vein was performed. In our clinical experience of 30 consecutive patients with hemorrhagic cardiac tamponade, this technique was successful to limit blood transfusions, to prevent further clinical worsening and bridge patients with intractable bleeding, to cardiac surgery. No major adverse reactions were directly related to blood autotransfusion. In the complex clinical scenario of acute tamponade occurring during catheter-based cardiac procedures, autotransfusion of pericardial blood through a femoral vein is safe and effective. It can be a useful trick up the sleeve of the interventional cardiologist.

Blood pressure variability, heart functionality, and left ventricular tissue alterations in a protocol of severe hemorrhagic shock and resuscitation.

Autonomic control of blood pressure (BP) and heart rate (HR) is crucial during bleeding and hemorrhagic shock (HS) to compensate for hypotension and hypoxia. Previous works have observed that at the point of hemodynamic decompensation a marked suppression of BP and HR variability occurs, leading to irreversible shock. We hypothesized that recovery of the autonomic control may be decisive for effective resuscitation, along with restoration of mean BP. We computed cardiovascular indexes of baroreflex sensitivity and BP and HR variability by analyzing hemodynamic recordings collected from five pigs during a protocol of severe hemorrhage and resuscitation; three pigs were sham-treated controls. Moreover, we assessed the effects of severe hemorrhage on heart functionality by integrating the hemodynamic findings with measures of plasma high-sensitivity cardiac troponin T and metabolite concentrations in left ventricular (LV) tissue. Resuscitation was performed with fluids and norepinephrine and then by reinfusion of shed blood. After first resuscitation, mean BP reached the target value, but cardiovascular indexes were not fully restored, hinting at a partial recovery of the autonomic mechanisms. Moreover, cardiac troponins were still elevated, suggesting a persistent myocardial sufferance. After blood reinfusion all the indexes returned to baseline. In the harvested heart, LV metabolic profile confirmed the acute stress condition sensed by the cardiomyocytes. Variability indexes and baroreflex trends can be valuable tools to evaluate the severity of HS, and they may represent a more useful end point for resuscitation in combination with standard measures such as mean values and biological measures.NEW & NOTEWORTHY Autonomic control of blood pressure was highly impaired during hemorrhagic shock, and it was not completely recovered after resuscitation despite global restoration of mean pressures. Moreover, a persistent myocardial sufferance emerged from measured cardiac troponin T and metabolite concentrations of left ventricular tissue. We highlight the importance of combining global mean values and biological markers with measures of variability and autonomic control for a better characterization of the effectiveness of the resuscitation strategy.

Sangre autóloga a reinfundir con el recuperador celular a pacientes cardíacos en respuesta a las transfusiones sanguíneas

Introduction and objetivesThe cell saver is an alternative to blood transfusions according to the existing evidence. However, there is no evidence to determine the time of reinfusion of red blood cells in line with transfusions. Our objective was to analyze the evidence on the effectiveness of the cell saver to reduce blood transfusions. MethodsRandomized clinical trial with 91 patients in a non-exposed group (reinfusion of autologous blood with the cell saver was performed at the end of surgery) and 80 patients exposed group (reinfusion of autologous blood was performed continuously during surgery). Variables were collected at three moments (preoperative, intraoperative and postoperative). ResultsBoth haemoglobin and haematocrit were lower in the unexposed group when compared to the exposed group, both during after surgery (p=.011 and.018, respectively), and blood transfusions were higher in the unexposed group both during, and after surgery (p=.001). ConclusionsIn order to reduce the transfusion rate of cardiac patients as much as possible, the optimal time to reinfuse autologous blood from the cell saver should be during the surgery, according to a continuous reinfusion protocol.

Emergency sternal intraosseous access for warm fresh whole blood transfusion in damage control resuscitation.

Intraosseous (IO) vascular access is increasingly used as an emergency tool for achieving access to the systemic circulation in critically ill patients. The role of IO transfusion of blood in damage control resuscitation is however questionable due to possible inadequate flow rate and hemolysis. Some experts claim that IO transfusion is contraindicated. In this study, we have challenged this statement by looking at flow rates of autologous fresh whole blood reinfusion and hemolysis using two of the commonly used Food and Drug Administration-approved and Conformité Européenne (CE)-marked sternal needles. Additionally, the success rate of sternal access between the two devices is evaluated. Volunteer professional military personnel, were enrolled prospectively in a nonrandomized observational study design. We collected 450 mL of autologous whole blood from each participant. Participants were divided into the following three groups of 10: Tactically Advanced Lifesaving IO Needle (T.A.L.O.N.) IO, FAST1 IO, and intravenous group. The reinfusion was done by gravity only. Blood sampling was performed before blood collection and 30 minutes after reinfusion. Investigation of hemolysis was performed by measurements of haptoglobin and lactate dehydrogenase. Success rate was evaluated by correct aspiration of bone marrow. Median reinfusion rate was 46.2 mL/min in the FAST1 group, 32.4 mL/min in the T.A.L.O.N. group, and 74.1 mL/min in the intravenous group. Blood samples from all participants were within normal ranges. There was no statistically significant difference in haptoglobin and lactate dehydrogenase between the groups. In the FAST1 group, 1 (9%) of 11 procedures failed. In the T.A.L.O.N. group, 4 (29%) of 14 procedures failed. Although preferable, achieving peripheral venous access in the bleeding patient is a major problem. Our findings suggest that fresh whole-blood transfusion through the IO route is safe, reliable, and provide sufficient flow for resuscitation. Therapeutic/Care management study, level III.

Efficacy and safety of granulocyte adsorption apheresis in elderly patients with ulcerative colitis.

Elderly ulcerative colitis (UC) is increasing. Elderly UC differ from younger UC with respect to the course of their disease. Granulocyte adsorption apheresis (CAP) is often used to treat elderly UC. We retrospectively analyzed the cases of elderly UC who underwent CAP for remission induction therapy in a comparison with younger UC. 96 patients with UC underwent CAP. Patients who concurrently received tacrolimus, biological agents, or high-dose steroid therapy were excluded. The remaining 80 patients were evaluated. We divided them into an elderly group (aged ≥65 years) and a younger group, and then we compared the groups' (1) clinical characteristics, (2) the efficacy and adverse effects of CAP, and (3) the complications of PSL. The remission rate was 70.8% in the elderly group and 87.5% in the younger group. There were significant differences between the two groups with respect to the age at the onset of UC, the estimated glomerular filtration rate on admission, underlying diseases, and complications of PSL therapy. Adverse effects of CAP included headache, complications of blood reinfusion, heparin allergy, hypotension, and failure of blood removal. There were significant differences between the two groups with respect to the complications of PSL therapy (all P<.05). Although the elderly group had longer durations of UC, a higher prevalence of underlying diseases, and a higher frequency of adverse events due to PSL therapy. No serious adverse effects of CAP occurred in either group. Thus, CAP was safe and effective in both younger and elderly UC.

Changes in hemoglobin profile reflect autologous blood transfusion misuse in sports

The changes in hemoglobin (Hb) profile following autologous blood transfusion (ABT) for the first time were studied for anti-doping purposes. Twenty-four healthy, trained male subjects (aged 18‒40) were enrolled and randomized into either the transfusion (T) or control (C) groups. Blood samples were taken from the T subjects at baseline, after withdrawal and reinfusion of 450ml of refrigerated or cryopreserved blood, and from C subjects at the same time points. Hematological variables (Complete blood count, Reticulocytes, Immature Reticulocytes Fraction, Red-cell Distribution Width, OFF-hr score) were measured. The Hb types were analyzed by high-performance liquid chromatography and the Hemoglobin Profile Index (HbPI) arbitrarily calculated. Between-group differences were observed for red blood cells and reticulocytes. Unlike C, the T group, after withdrawal and reinfusion, showed a significant trend analysis for both hematological variables (Hemoglobin concentration, reticulocytes, OFF-hr score) and Hb types (glycated hemoglobin-HbA1c, HbPI). The control charts highlighted samples with abnormal values (> 3-SD above/below the population mean) after reinfusion for hematological variables in one subject versus five subjects for HbA1c and HbPI. A significant ROC-curve analysis (area = 0.649, p = 0.015) identified a HbA1c cut-off value ≤ 2.7% associated to 100% specificity of blood reinfusion (sensitivity 25%). Hemoglobin profile changed in trained subjects after ABT, with abnormal values of HbA1c and HbPI in 42% of subjects after reinfusion. Future studies will confirm the usefulness of these biomarkers in the anti-doping field.

Risk factors for autologous blood withdrawal-reinfusion in cesarean section

Objective To determine the risk factors for autologous blood withdrawal-reinfusion in cesarean section. Methods Parturients who underwent cesarean section and autologous blood withdrawal from August 2012 to June 2015 in our hospital were selected.The preoperative, intraoperative and postoperative data of the parturients were collected retrospectively from electronic medical records.The parturients were divided into reinfusion group and non-reinfusion group according to whether the parturients received autologous blood reinfusion.Logistic regression analysis was used to stratify the risk factors for autologous blood withdrawal-reinfusion in cesarean section. Results A total of 1 604 parturients who received autologous blood reinfusion were included in the study, with 757 cases in reinfusion group and 847 cases in non-reinfusion group.Placenta increta/percreta, placenta previa with previous uterine surgery and complete placenta previa were the risk factors for autologous blood withdrawal-reinfusion in cesarean section (P<0.05). The predictive model was exp(w)÷[1+ exp(w)], w=1.447×placenta increta/percreta (corrected OR value)+ 0.945×complete placenta previa (corrected OR value)+ 1.361×placenta previa with previous uterine surgery (corrected OR value). The sensitivity and specificity of this model in predicting blood reinfusion were 56% and 79%, respectively, the positive predictive value was 71%, and the negative predictive value was 67%. Conclusion Placenta increta/percreta, placenta previa with previous uterine surgery and complete placenta previa are high risk factors for autologous blood withdrawal-reinfusion in cesarean section, and routine preparation for autologous blood withdrawal-reinfusion is recommended. Key words: Cesarean section; Blood transfusion, autologous

Bicaval dual lumen cannula in adult veno-venous extracorporeal membrane oxygenation-clinical pearls for safe cannulation.

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been traditionally delivered with two independent cannulae at different venous insertion sites. The bicaval dual lumen cannula has gained popularity as a cannula for simultaneous venous drainage and reinfusion of blood via the internal jugular vein (IJV). Its insertion requires special attention to details to prevent the occurrence of serious complications. In this review, we discuss different techniques of cannula insertion and tips for troubleshooting.

Cerebral oxygenation during umbilical arterial blood sampling in very low birth weight neonates

Umbilical arterial blood sampling (UABS) has been associated with cerebral oxygen saturation (CrSO2) decrements in very low birth weight (VLBW) neonates. We sought to determine patient- and UABS procedure-related factors contributing to this effect. In this prospective cohort study, cerebral near-infrared spectroscopy was performed during UABS procedures in VLBW neonates. Analyses were conducted to determine subject- and procedure-related factors correlating with CrSO2 decrements. Thirty subjects (mean (±SD) 27 ± 2 week GA and 1058 ± 279 g BW) underwent 84 UABS procedures between 5 and 183 postnatal hours. Six (20%) experienced CrSO2 decrements, less than previously reported. Subjects with CrSO2 decrements had earlier GA and lower BW, though these were not statistically significant differences. CrSO2 decrements occurred with lower pre- and post-UABS pulse oximetry (p = 0.004; p < 0.001), lower arterial oxygen partial pressure (p < 0.001), lower baseline CrSO2 (p = 0.01), and faster "priming" blood reinfusion (p = 0.03) and saline flush (p = 0.02). UABS procedures appear to be associated with CrSO2 decrements more commonly among VLBW neonates already experiencing disturbances in cerebral oxygen delivery-consumption balance. Shorter durations of UABS procedural components may contribute to CrSO2 decrements.

Comparing methods of tranexamic acid administration and blood reinfusion in reducing blood loss during total knee arthroplasty.

Background: Perioperative blood loss is associated with total knee arthroplasty (TKA). The tranexamic acid (TXA) is a plasminogen activator inhibitor widely used to prevent bleeding. The Stryker CBC II ConstaVac Blood Conservation System (CBC II, Stryker) can avoid homologous blood. The purpose of this study is to compare the efficacy of intravenous and topical regimen of TXA in primary TKA, and compare the efficacy of TXA and CBC II in primary TKA. Methods: The study included 202 patients accepted primary TKA from May 2010 to May 2015. The patients were divided into four groups: 53 patients were administered intravenously with 1000 mg TXA. 54 patients in an age and gender-matched group were topical administration with 1000mg of TXA in 100 cc of saline. 49 patients in an age and gender-matched control group undergo the treatment of blood reinfusion by CBC II. Control group included 46 patients did not take TXA and CBC II. Results: Post-operative 24 h total drainage volume were lowest, and the post-operative 24 h Hgb was highest in the group administered intravenously of TXA (p<0.05). The transfusion rate, amount of red blood cell suspension and frozen plasma were lowest in the administered intravenously of TXA group (p<0.05). Here was no thromboembolic event in four groups. Conclusions: Perioperative blood loss could be reduced by intravenous and topical regimen of TXA and CBC II after TKA. In addition, the application of TXA and CBC II is not associated with increased risk of thromboembolic complications.

The predictive value of hemodynamics change on fluid responsiveness during renal replacement therapy including both blood drainage and reinfusion in critically ill patients

The predictive value of hemodynamics change on fluid responsiveness during renal replacement therapy including both blood drainage and reinfusion in critically ill patients

Resuscitation Fluid with Drag Reducing Polymer Enhances Cerebral Microcirculation and Tissue Oxygenation After Traumatic Brain Injury Complicated by Hemorrhagic Shock.

TBI was induced in rats by fluid percussion (1.5atm, 50ms) followed by controlled hemorrhage to a mean arterial pressure (MAP)=40mmHg. DRP-RF or lactated Ringer (LR-RF) was infused to MAP of 60mmHg for 1h (pre-hospital), followed by blood re-infusion to a MAP=70mmHg (hospital). Temperature, MAP, blood gases and electrolytes were monitored. In vivo 2-photon laser scanning microscopy was used to monitor microvascular blood flow, hypoxia (NADH) and necrosis (i.v. propidium iodide) for 5h after TBI/HS followed by MRI for CBF and lesion volume. TBI/HS compromised brain microvascular flow leading to capillary microthrombosis, tissue hypoxia and neuronal necrosis. DRP-RF compared to LR-RF reduced microthrombosis, restored collapsed capillary flow and improved mvCBF (82 ± 9.7% vs. 62 ± 9.7%, respectively, p<0.05, n=10). DRP-RF vs LR-RF decreased tissue hypoxia (77 ± 8.2% vs. 60 ± 10.5%, p<0.05), and neuronal necrosis (21 ± 7.2% vs. 36 ± 7.3%, respectively, p<0.05). MRI showed reduced lesion volumes with DRP-RF. DRP-RF effectively restores mvCBF, reduces hypoxia and protects neurons compared to conventional volume expansion with LR-RF after TBI/HS.

RIGHT-SIDED HEMIHEPATECTOMY WITH CIRCULAR RESECTION AND INFERIOR VENA CAVA REPLACEMENT FOR LOCALLY-ADVANCED LIVER ALVEOCOCCOSIS

It is presented the case report of liver alveococcosis complicated by invasion of inferior vena cava. Right-sided hemihepatectomy with circular resection and replacement of suprarenal inferior vena cava was performed. Synthetic PTFE prosthesis reinforced by rings for better framework function and less possibility of thrombosis was used for inferior vena cava reconstruction. We applied total vascular isolation of liver. Cell Saver was obligatory for autologous blood re-infusion. The severity of post-resection liver failure, biliary complications, postoperative hemorrhage were evaluated by ISGLS criteria. There are no signs of recurrence within follow-up.