Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-24T02:55:26.242Z Has data issue: false hasContentIssue false

Chapter 14 - Assessment of Intraoperative Blood Loss

Published online by Cambridge University Press:  28 April 2020

By
Kyle James Riley  and
Daniel Katz
Edited by
Andrew B. Leibowitz  and
Suzan Uysal
Andrew B. Leibowitz
Affiliation:
Icahn School of Medicine at Mount Sinai
Suzan Uysal
Affiliation:
Icahn School of Medicine at Mount Sinai
Get access

Summary

To reduce unneeded red blood cell transfusions and to avoid surgery-induced anemia, it is important to have accurate and timely assessment of intraoperative blood loss. This chapter briefly outlines the American Society of Anesthesiologists and the AABB guidelines regarding assessment and management of blood loss. It describes the primary methods for determining blood loss, including visual assessment, photometric analysis, gravimetric blood loss determination, blood loss formulas using hemoglobin and hematocrit monitoring, and imaging analysis. The chapter concludes with a summary comparing the major advantages and disadvantages of each blood loss monitoring methodology.

Keywords

Interoperative blood lossvisual blood loss estimationphotometric analysisgravimetric blood loss determinationblood loss formulasimaging analysis
Type
Chapter
Information
Modern Monitoring in Anesthesiology and Perioperative Care , pp. 139 - 147
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Doctorvaladan, S, Jelks, A, Hsieh, E, et al. Accuracy of blood loss measurement during cesarean delivery. Am J Perinatol Reports 2017;7:e93–100.Google Scholar
Barrachina, B, Lopez-Picado, A, Remon, M, et al. Tranexamic acid compared with placebo for reducing total blood loss in hip replacement surgery. Anesth Analg 2016;122:986–95.Google Scholar
Frank, SM, Savage, WJ, Rothschild, JA, et al. Variability in blood and blood component utilization as assessed by an anesthesia information management system. Anesthesiology 2012;117:99–106.Google Scholar
Guinn, NR, Broomer, BW, White, W, Richardson, W, Hill, SE. Comparison of visually estimated blood loss with direct hemoglobin measurement in multilevel spine surgery. Transfusion 2013;53:2790–4.Google Scholar
Awada, WN, Mohmoued, MF, Radwan, TM, Hussien, GZ, Elkady, HW. Continuous and noninvasive hemoglobin monitoring reduces red blood cell transfusion during neurosurgery: a prospective cohort study. J Clin Monit Comput 2015;29:733–40.Google Scholar
Ehrenfeld, JM, Henneman, JP, Bulka, CM, Sandberg WS. Continuous non-invasive hemoglobin monitoring during orthopedic surgery: a randomized trial. J Blood Disord Transfus 2014;5(237):1–5.Google Scholar
Standards for Basic Anesthetic Monitoring – American Society of Anesthesiologists., www.asahq.org/quality-and-practice-management/practice-guidance-resource-documents/standards-for-basic-anesthetic-monitoring accessed: 11/11/2017.Google Scholar
Practice Guidelines for Perioperative Blood Management. Anesthesiology 2015;122:241–75.Google Scholar
www.aabb.org/ accessed: 11/12/2017Google Scholar
Wiegmann, TL, Mintz, PD. The growing role of AABB clinical practice guidelines in improving patient care. Transfusion 2015;55:935–6.Google Scholar
Tobian, AAR, Heddle, NM, Wiegmann, TL, Carson, JL. Red blood cell transfusion: 2016 clinical practice guidelines from AABB. Transfusion 2016;56:2627–30.Google Scholar
Yazer, MH, Triulzi, DJ, DI, S. AABB red blood cell transfusion guidelines. JAMA 2016;316:1984–5.Google Scholar
Carson, JL, Guyatt, G, Heddle, NM, et al. Clinical practice guidelines from the AABB. JAMA 2016;316:2025–35.CrossRefGoogle ScholarPubMed
Carson, JL, Grossman, BJ, Kleinman, S, et al. Red blood cell transfusion: a clinical practice guideline from the AABB*. Ann Intern Med 2012;157:49–58.Google Scholar
Sharareh, B, Woolwine, S, Satish, S, Abraham, P, Schwarzkopf, R. Real time intraoperative monitoring of blood loss with a novel tablet application. Open Orthop J 2015;9:422–6.Google Scholar
Schorn, MN. Measurement of blood loss: review of the literature. J Midwifery Womens Health 2010;55:20–7.CrossRefGoogle ScholarPubMed
Stafford, I, Dildy, GA, Clark, SL, Belfort, MA. Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol 2008;199:519.e1-7.CrossRefGoogle ScholarPubMed
Bose, P, Regan, F, Paterson-Brown, S. Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG 2006;113:919–24.Google Scholar
Dildy, GA, Paine, AR, George, NC, Velasco, C. Estimating blood loss: can teaching significantly improve visual estimation? Obstet Gynecol 2004;104:601–6.Google Scholar
Eipe, N, Ponniah, M. Perioperative blood loss assessment – How accurate? Indian J Anaesth 2006;50:35–8.Google Scholar
Toledo, P, Eosakul, ST, Goetz, K, Wong, CA, Grobman, WA. Decay in blood loss estimation skills after web-based didactic training. Simul Healthc 2012;7:18–21.CrossRefGoogle ScholarPubMed
Holmes, AA, Konig, G, Ting, V, et al. Clinical evaluation of a novel system for monitoring surgical hemoglobin loss. Anesth Analg 2014;119:588–94.Google Scholar
Konig, G, Holmes, AA, Garcia, R, et al. In vitro evaluation of a novel system for monitoring surgical hemoglobin loss. Anesth Analg 2014;119:595–600.Google Scholar
Gauss, S. Triton L&D – Gauss Surgical, www.gausssurgical.com/tritonld accessed:12/04/2019Google Scholar
Gauss, S. Gauss Surgical Receives FDA Clearance for Second Generation Triton for Real-Time Monitoring of Surgical Blood Loss – Gauss Surgical., www.gausssurgical.com/news/2017/6/22/gauss-surgical-receives-fda-clearance-for-second-generation-triton-for-real-time-monitoring-of-surgical-blood-loss accessed:12/04/2019.Google Scholar
Kallos, T, Smith, TC. Replacement for intraoperative blood loss. Anesthesiology 1974;41:293–5.Google Scholar
Bourke, DL, Smith, TC. Estimating allowable hemodilution. Anesthesiology 1974;41:609–11.CrossRefGoogle ScholarPubMed
Ward, CF, Meathe, EA, Benumof, JL, Trousdale, F. A computer nomogram for loss replacement. Anesthesiology 1980;53:S126.Google Scholar
Gross, JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology 1983;58:277–80.Google Scholar
Camarasa, MA, Ollé, G, Serra-Prat, M, et al. Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement: a randomized clinical trial. Br J Anaesth 2006;96:576–82.Google Scholar
Lopez-Picado, A, Albinarrate, A, Barrachina, B. Determination of perioperative blood loss: accuracy or approximation? Anesth Analg 2017;125:280–6.Google Scholar
Mercuriali, F, Inghilleri, G. Proposal of an algorithm to help the choice of the best transfusion strategy. Curr Med Res Opin 1996;13:465–78.Google Scholar
Vos, JJ, Kalmar, AF, Struys, MM, et al. Accuracy of non-invasive measurement of haemoglobin concentration by pulse co-oximetry during steady-state and dynamic conditions in liver surgery. Br J Anaesth 2012;109:522–8.Google Scholar
Maslow, A, Bert, A, Singh, A, Sweeney, J. Point-of-care hemoglobin/hematocrit testing: comparison of methodology and technology. J Cardiothorac Vasc Anesth 2016;30:352–62.CrossRefGoogle ScholarPubMed
Lamhaut, L, Apriotesei, R, Combes, X, et al. Comparison of the accuracy of noninvasive hemoglobin monitoring by spectrophotometry (SpHb) and HemoCue® with automated laboratory hemoglobin measurement. Anesthesiology 2011;115:548–54.Google Scholar
Konig, G, Waters, JH, Javidroozi, M, et al. Real-time evaluation of an image analysis system for monitoring surgical hemoglobin loss. J Clin Monit Comput 2018;32:303–10.Google Scholar
Rubenstein, A, Zamudio, S, Al-Khan, A, et al. Clinical experience with the implementation of accurate measurement of blood loss during cesarean delivery: influences on hemorrhage recognition and allogeneic transfusion. Am J Perinatol 2018;35:655–9.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×