This is a sound clinical study presenting valid data on transfusion practices in non-cardiac intensive care units. – Volker Kretschmer
An assessment of the management of acute bleeding varices: a multicenter prospective member-based study.
The survey gives a good and very detailed overview about cause and current management of acute bleeding varices including rebleeding and lethality. However, no data except the amount of blood products is given about the indication and need of blood components as well as influence of therapy with blood components on outcome. In addition, no […]
Efficacy, recovery, and safety of RBCs from autologous placental blood: clinical experience in 52 newborns.
Another optimistic article about the use of autologous placental blood in order to reduce exposure to allogeneic donor blood. A benefit was observed in almost 60% of neonates with a birth weight of 1000 to 2500 g and in those requiring surgery, but not in the very premature neonates (< 1000 g). No adverse effects […]
Risk of recurarization during retransfusion of autologous blood withdrawn after injection of muscle relaxants: A comparison of rocuronium and mivacurium.
Important information concerning the risk of recurarization when mivacurium and rocuronium have been administered prior to the removal of autologous blood in ANH. The anesthetist should be aware of this possibility when autologous blood is retransfused. – Konrad Messmer
An extremely large group of patients having bilateral knee arthroplasty has been studied. Without blood conservation measures, 98% required allogeneic transfusion! This study shows the somewhat limited benefits of predonation (a 2 unit donation reduced the rate to 51%). Addition of a cell saver showed significant benefit,i.e. only 8% allogeneic transfusion. Trying to untangle the […]
Good overview about the bacterial risk in blood transfusion, and the currently discussed methods to reduce this risk. – Volker Kretschmer
Discussion of very recent literature, calculation of current risk of transfusion transmitted viral infections after introduction of NAT-HCV and NAT-HIV. Determination of cost/benefit of introduction of NAT. Conclusive statement that p24 antigen testing should be omitted after introducztion of NAT. – Volker Kretschmer
Hydroxyethyl starch (HES) 130/0.4 provides larger and faster increases in tissue oxygen tension in comparison with prehemodilution values than HES 70/0.5 or HES 200/0.5 in volunteers undergoing acute normovolemic hemodilution.
This prospective randomized double-blinded crossover study demonstrated that hydroxyethyl starch specifications (in vitro molecular weight, degree and pattern of substitution) could significantly alter muscular tissue oxygen tension used as an indicator of blood rheology. The better results obtained with HES 130/0.4 might be attributed to the optimum “in vivo” molecular size achieved by this hydroxyethyl […]
In this observational study, the authors report their experience with the use of acute normovolemic hemodilution in cardiac surgery patients. – Philippe Van der Linden This article convincingly shows that ANH in patients undergoing cardiac surgery significantly reduces the need for allogeneic blood transfusion. Autologous blood removed ranged from 1 (70%) to 2-5 (30% of […]
A prospective randomized study comparing two techniques of perioperative blood conservation: Isovolemic hemodilution and hypervolemic hemodilution.
This prospective randomized study reports that hypervolemic hemodilution using urea-linked gelatin is as efficient as moderate isovolemic hemodilution in reducing allogeneic blood exposure in ASA I and II patients undergoing elective non-cardiac surgery. – Philippe Van der Linden
In this excellent paper, the authors develop a mathematical model that may help our understanding of the efficiency of blood salvage. The basic insights from these theoretical considerations are that we should make all efforts to increase RBC recovery from the surgical field and use smaller bowls for low-weight and low-hematocrit patients. Difficulties in translating […]
Autologous blood sequestration using a double venous reservoir bypass circuit and polymerized hemoglobin prime.
This experimental study describes a modified cardiopulmonary bypass circuit using a bovine hemoglobin solution priming that protects a portion of the autologous blood volume from the damaging effects of bypass. – Philippe Van der Linden The authors conducted an animal experiment to evaluate the efficacy of a novel double venous reservoir bypass circuit, used in […]
This case control cohort study reports that the efficacy of acute normovolemic hemodilution as a blood conservation technique appears limited due to the usually poor clinical status of patients undergoing femoro-distal bypass grafts. – Philippe Van der Linden
This retrospective study nicely demonstrates that the use of a simple algorithm taking into account the type of operation and the preoperative hemoglobin concentration can be effective in identifying patients likely to require perioperative allogeneic blood transfusion. – P. Van der Linden Although no clear transfusion trigger was used, the algorithm allows a significant reduction […]
Beta-adrenergic stimulation restores, oxygen extraction reserve during acute normovolemic hemodilution.
This experimental study demonstrates that the blunting of the cardiac output response to acute normovolemic hemodilution during anesthesia can be reversed by the administration of a beta-adrenergic drug. – Philippe Van der Linden