Blood loss and blood transfusion
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Manual of Neuroanesthesia, 2017
The World Health Organization (WHO) recognized patient blood management in 2010 as the new standard of care.2 These protocols are being recommended for the perioperative management of blood products and adjuvant therapies to optimize patient outcome and minimize transfusion. Patient blood management is currently defined by the Society for the Advancement of Blood Management (available at http://www.sabm.org) as “the timely application of evidence based medical and surgical concepts designed to maintain haemoglobin, optimize haemostasis and minimise blood loss in an effort to improve patient outcome.” There is a paradigm shift from the previous transfusion-centric approach to a patient-centric approach, that is, primarily relying on the patient's blood rather than donor blood. This change has occurred due to an increasing gap between blood supply-to-demand ratio, escalating costs, concerns about product safety, adverse outcomes with transfusion, and questionable efficacy of transfusion. It is suggested to address the following three pillars of patient blood management (PBM)3 to minimize blood usage so that the risks of blood transfusion can be minimized while maximizing clinical outcome: First pillar: Optimize hematopoiesisSecond pillar: Minimize blood loss and bleedingThird pillar: Optimize tolerance of anemia
Anaesthesia in Orthopaedic Surgery
Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou in Operative Orthopaedics, 2020
The goal of intravenous fluid therapy is to maintain normovolaemia. This allows adequate cardiac output and, assuming an appropriate haemoglobin concentration, tissue oxygen delivery. Maintenance water and electrolytes need to be supplied and ongoing blood loss compensated for in the form of blood substitute, or blood itself. Patient blood management has recently been advocated for the perisurgical period to enable treating physicians to have the time and tools to provide patient-centered evidenced-based care to minimise allogeneic blood transfusions. It aims to optimise erythropoiesis, minimise blood loss and manage anaemia.
Ankylosing Spondylitis: Complications Related to Spine Surgery
Barend J. van Royen, Ben A. C. Dijkmans in Ankylosing Spondylitis Diagnosis and Management, 2006
Profuse blood loss can be a problem encountered during osteotomy surgery, often from the osteoporotic bone and the epidural veins. It may partly be caused by high intra-abdominal pressures due to difficulties in adequately positioning these often very stooped patients. Adequate blood management must of course be applied. Intraoperatively routine surgical measures can be taken, using bipolar electrocautery, gelfoam, and other clotting agents, but in extreme cases it may be necessary to pack the wound and delay further surgery to a second stage at a later date.
Acute myeloid leukemia: challenges for diagnosis and treatment in Latin America
Published in Hematology, 2023
Andrés Gómez-De León, Roberta Demichelis-Gómez, Abel da Costa-Neto, David Gómez-Almaguer, Eduardo Magalhães Rego
Transfusion support is key and the availability of plateletphereses can be challenging, as less than half of the blood supply in LA comes from altruistic donors [43]. Optimization of blood products through patient blood management programs is highly important [44]. Avoiding sibling and family directed donation becomes even more relevant, as the generation of anti-HLA donor-specific antibodies can become a barrier for haploidentical hematopoietic stem cell transplantation (HSCT) [45]. Thus, characteristics of the treatment center itself are of key importance and can improve or limit the capacity to deliver supportive care; induction mortality is inversely correlated with center specialization and experience [27,30,46]. ICU capacity and access, nursing, and quality management, establishment of outreach programs for timely referral to leukemia centers, and a multidisciplinary treatment team with continued education are all relevant factors that should be increasingly fostered and developed in our region [46]. Implementation of practices known to be successful is challenging but can likely save more lives worldwide than any diagnostic study or novel agent addition to the current standard management [41]. Furthermore, novel induction strategies such as early discharge and outpatient follow-up can decrease exposures, costs, and improve quality of life [47]. This strategy has been adopted successfully in the context of allogeneic HSCT in Mexico even in centers without a conventional transplant unit [48].
Management of patients with rare blood groups in maternity
Published in Journal of Obstetrics and Gynaecology, 2020
Shannon Pytel, Pierre-François Ceccaldi, Salim Idri, Jordan Ohayon, Diana Badoiu
The management of rare blood groups in obstetrics requires excellent interdisciplinary coordination. In recent years, we have attempted to find a minimum level of care for these personalised blood management situations. The survey of these pregnant women takes into account the maternal risk of ‘transfusion deadlock’ and haemolytic disease of the newborn. The majority of our patients had one or more risk factors associated with severe postpartum haemorrhage identified in the literature: age ≥35 y, parity ≥3, history of Caesarean section or uterine surgery, ethnic origin, abnormal placentation, birth weight > 4500 g, in-labour or elective Caesarean section, but none of them had anaemia (Hb≤9 g/dL) in early pregnancy (Al-Zirqi et al. 2008; Nyfløt et al. 2017). The timing must ensure a recommended haemoglobin level at the time of delivery, for us approximately 12 g/dL. We have determined that the procedure to be followed should be planned in as much detail as possible by no later than 35 WG.
Prevalence of G6PD deficiency in Thai blood donors, the characteristics of G6PD deficient blood, and the efficacy of fluorescent spot test to screen for G6PD deficiency in a hospital blood bank setting
Published in Hematology, 2022
Phinyada Rojphoung, Thongbai Rungroung, Usanee Siriboonrit, Sasijit Vejbaesya, Parichart Permpikul, Janejira Kittivorapart
The prevalence of G6PD deficiency in this study was 7.59%. FST was demonstrated to be an effective and reliable method for G6PD deficiency screening among Thai blood donors in a hospital blood bank setting. Changes to the blood management policies at our center based on the findings of this study include: 1) G6PD deficient products will not be stored for more than 14 days, and 2) G6PD deficiency blood products will not be transfused to neonates for exchange transfusion or chronic transfusion dependent patients. To our knowledge, this is the first study to assess the in vitro quality of G6PD deficient RBC products in Thailand, which is a country with a high prevalence of moderate to mild G6PD enzyme deficiency.
Related Knowledge Centers
- Anemia
- Blood Transfusion
- Hematology
- Hematocrit
- Intraoperative Blood Salvage
- Family Medicine
- Surgeon
- Transfusion Practitioner
- Choosing Wisely
- Erythropoietin