Surgical blood use in cardiac surgery Flashcards
“In the late 50s…it was typical to transfuse
15-20 units of atologus whole blood per case
The average blood use per case in 1979 was
8.5 units
What drives transfusion variables?
Surgeon: %
Disease variables : %
Patient variables: %
Surgeon 56%
Disease variables 9%
Patient variables 35%
What is the perfect Hct to come of CPB?
23 - 24 Hct
Mortality post CPB was directly influenced by
transfusion
Jehova’s Witnesses Believe that blood transfusions are absolutely prohibited by God.
Population in the USA?
- 5 million followers
* 20% in the USA
What blood products are off limits when managing JW’s?
- PRBC
- Platelets
- FFP
What blood products are acceptable when managing JW’s?
- Albumin
- Fibrinogen
- (Cryo)
NY Hospital - Cornell Medical Center Protocol. If Hct. < 18% delay surgery and treat with_____. > 18% proceed with surgery.
EPO
After 5-7 days at high dose EPO regimen Hct. can get what type of increase?
2 -3 % increase per day
In regard to managing JW’s patients, all blood in ECC must be kept in ?
continuous circulation with the patients vascular system
3 facts of Directed Donors?
- risk of disease transmission is as much as 2x in DD blood pool vs the standard homologus pool.
- Reduce ability to receive a bone marrow transplant from relatives in the future.
- Costly, without reducing risk of infection therefore, reimbursement is poor.
(PAD)
Preoperative donation
IADH definition
intraoperative donation with hemodilution
– Performed by anesthesia
IAD definition
Intra operative donation without hemodilution
– Performed by the perfusionist
Cell Saver Techniques
– Preoperative / intraoperative apheresis
– Shed blood collection
• Intraoperative cell salvage
• Postoperative drainage
Advantages of autologous blood?
- ↓ donor exposure
- ↓ chance of disease transmission
- Prevents alloimmunoization
- Eliminates transfusion reaction
- Reduced storage lesion /increased component function
Disadvantages of autologous blood?
• Infusion of activated compliment system
4 Things to be aware of with Autologus donation
– Outdated Blood
– Admin. of wrong blood
– Units should be administered in proper sequence
– Blood stored at room temp may culture bacterial contamination
Pre-operative Autologus Donation is often supplemented with what?
IM injections of Iron or EPO.
Risk of Pre-operative Autologus Donation?
preoperative anemia (RBC volume does not recover to baseline before surgery
4 risks of Pre-operative Autologus Donation ?
- Of limited value to unstable patients
- Impossible for emergent patients
- Introduces storage lesion into otherwise fresh blood
- Unnecessary cost and inconvenience
Storage and handling of IAD (Intraoperative donation at the pump).
- 8 hr expiration if stored at room temp.
* 24 hour expiration if stored at 1-6°C within 6 hours of collection
Storage and handling of IAD, you should not ?
Do not refrigerate platelets
