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2 results

  • Chapter 16 - Coagulopathy and Hematological Disorders Associated with Cardiopulmonary Bypass

  • Edited by Florian Falter, Albert C. Perrino, Jr, Robert A. Baker
  • Book:
    Cardiopulmonary Bypass
    Published online:
    24 October 2022
    Print publication:
    10 November 2022, pp 156-165

  • Summary

    CPB as well as surgical trauma have a significant impact on the usually well-balanced coagulation system. This often leads to bleeding complications, and interventions to restore this balance are frequently attempted perioperatively. The coagulation and inflammatory systems are so complex that restoration of homeostatic balance cannot be achieved by giving blood products alone. Major known causes of CPB associated coagulopathy are dilution, complex and variable platelet dysfunction, fibrinolysis, the effects of heparin and protamine, hypocalcemia, hypothermia, as well as activation of the coagulation system after contact with artificial surfaces and from tissue factor release from the endothelium in response to ischemia and reperfusion.

  • Transfusion Therapy During War and Peace in Sarajevo

  • Mirza Begovic, Abdulah Kozlicic
  • Journal:
    Prehospital and Disaster Medicine / Volume 9 / Issue S1 / June 1994
    Published online by Cambridge University Press:
    28 June 2012, pp. S16-S19
    Print publication:
    June 1994
  • Objective:

    To investigate surgical blood usage during the siege of Sarajevo.

    Methods:

    Data on blood usage and pre-transfusion hematocrit (Hct) values from blood transfusion request forms in 250 wartime emergency surgical procedures during August through October 1992 (experimental group), and in 146 peacetime elective surgical procedures (control group) during April through June 1991 at the State Hospital of Sarajevo, were reviewed.

    Results:

    The mean number of blood units transfused per patient (blood usage rate) was 1.13 in the experimental group versus 2.56 in the control group (p <0.001). During the war, for blood conservation, normovolemic hemodilution was practiced widely. A significantly lower mean pre-transfusion Hct value of 0.21 was observed in the experimental group versus 0.27 in the control group (p <0.001).

    Conclusion:

    Blood-usage rate was lower during emergency surgical procedures in war than during elective surgical procedures in peacetime without apparent adverse patient outcome. This decrease in blood-usage rate in the face of increased numbers of trauma victims was the result of a planned blood-conservation program which included: stringent blood-usage criteria, and widespread implementation of casualty resuscitation using normovolemic hemodilution with colloid and crystalloid plasma substitutes.