Patient Blood Management and Perioperative Anaemia
- Author: S V Thakrar
- Full Title: Patient Blood Management and Perioperative Anaemia
- Category: #books
Highlights
- PBM focuses upon three pillars of care (Table 2): 1. The optimization of red cell mass and erythropoiesis before operation. 2. The minimization of blood loss. 3. The management of postoperative anaemia. (Page 1)
- Perioperative anaemia is an independent for increased length of hospital and intensive care stay, postoperative complications, and increased mortality risk factor (Page 1)
- Intraoperative management of blood loss may be influenced by surgical technique, anaesthetic blood loss reduction strategies, and pharmacological management. robot assisted, and endovascular Surgical technique is the key factor in determining perioperative blood loss. Minimally invasive surgery such as laparoscopic, techniques are associated with a reduction in blood loss when compared with open more invasive approaches. Meticulous haemostasis is vital in preventing perioperative bleeding. The use of intraoperative topical haemostatic agents, containing collagens, fibrin or thrombin, may assist in the control of local bleeding. The use of regional anaesthesia is an anaesthetic blood sparing strategy. Central neuraxial blockade has been shown to significantly reduce perioperative blood loss.10 Orthopaedic surgery remains the surgical speciality in which there is the most robust evidence for minimization of perioperative blood loss with the use of neuraxial blockade, and regional anaesthesia should be considered for all major joint surgery. Maintenance of a balanced physiology to aid optimal coagulation is essential: avoiding hypothermia, acidosis, and hypocalcaemia. Maintaining core body temperature above 35(cid:4)C, pH > 7.2 and ionized calcium > 1 mmol litre(cid:2)1 allows for optimum clot formation.11 Manipulation of cardiovascular physiology to improve the operative field can reduce blood loss for example hypotensive anaesthesia in sinus surgery, or the lowering of central venous pressure in hepatic resection. Careful patient positioning will improve surgical operating conditions and reduce blood loss, by ensuring that venous drainage is maintained. (Page 4)
- The recent NICE guidance however, concluded that the benefit from a reduction in the numbers of patients transfused was offset by a potential increase in mortality and thrombotic complications. NICE recommended that EPO should not be used in surgical patients to reduce blood transfusion. Therefore a haematologist must be involved in any decision to use EPO for severe preoperative anaemia (Page 4)
- Where there may be blood loss greater than 1000 ml, the use of intraoperative cell salvage is advocated. Cell salvage is performed with the use of a double lumen suction device to collect blood. Blood is stored within a reservoir with added anticoagulants. Once enough blood is collected RBCs are washed, filtered, suspended in saline, and returned to the patient. (Page 4)
- These inhibit fibrinolysis by their action at the active sites on plasminogen, inhibiting the activation of plasmin. TXA should be used prophylactically in major surgery where perioperative blood loss is predicted to be high. TXA has been shown to significantly reduce perioperative blood loss. The clinical randomization of an antifibrinolytic in significant haemorrhage (CRASH-2 trial) highlighted the benefit of early therapy with TXA in trauma induced bleeding. A significant decline in risk of death from haemorrhage with the early use of TXA in the trauma setting has been demonstrated (Page 5)
- In most surgical specialties, the use of postoperative drains is being reduced, often as a component of enhanced recovery after surgery programmes. The use of drains has been shown to increase blood transfusion rates in orthopaedic surgery. (Page 5)
- A single unit blood transfusion policy reduces transfusion rates and improves the economics of blood transfusion (Page 6)
Patient Blood Management and Perioperative Anaemia
- Author: S V Thakrar
- Full Title: Patient Blood Management and Perioperative Anaemia
- Category: #books
Highlights
- PBM focuses upon three pillars of care (Table 2): 1. The optimization of red cell mass and erythropoiesis before operation. 2. The minimization of blood loss. 3. The management of postoperative anaemia. (Page 1)
- Perioperative anaemia is an independent for increased length of hospital and intensive care stay, postoperative complications, and increased mortality risk factor (Page 1)
- Intraoperative management of blood loss may be influenced by surgical technique, anaesthetic blood loss reduction strategies, and pharmacological management. robot assisted, and endovascular Surgical technique is the key factor in determining perioperative blood loss. Minimally invasive surgery such as laparoscopic, techniques are associated with a reduction in blood loss when compared with open more invasive approaches. Meticulous haemostasis is vital in preventing perioperative bleeding. The use of intraoperative topical haemostatic agents, containing collagens, fibrin or thrombin, may assist in the control of local bleeding. The use of regional anaesthesia is an anaesthetic blood sparing strategy. Central neuraxial blockade has been shown to significantly reduce perioperative blood loss.10 Orthopaedic surgery remains the surgical speciality in which there is the most robust evidence for minimization of perioperative blood loss with the use of neuraxial blockade, and regional anaesthesia should be considered for all major joint surgery. Maintenance of a balanced physiology to aid optimal coagulation is essential: avoiding hypothermia, acidosis, and hypocalcaemia. Maintaining core body temperature above 35(cid:4)C, pH > 7.2 and ionized calcium > 1 mmol litre(cid:2)1 allows for optimum clot formation.11 Manipulation of cardiovascular physiology to improve the operative field can reduce blood loss for example hypotensive anaesthesia in sinus surgery, or the lowering of central venous pressure in hepatic resection. Careful patient positioning will improve surgical operating conditions and reduce blood loss, by ensuring that venous drainage is maintained. (Page 4)
- The recent NICE guidance however, concluded that the benefit from a reduction in the numbers of patients transfused was offset by a potential increase in mortality and thrombotic complications. NICE recommended that EPO should not be used in surgical patients to reduce blood transfusion. Therefore a haematologist must be involved in any decision to use EPO for severe preoperative anaemia (Page 4)
- Where there may be blood loss greater than 1000 ml, the use of intraoperative cell salvage is advocated. Cell salvage is performed with the use of a double lumen suction device to collect blood. Blood is stored within a reservoir with added anticoagulants. Once enough blood is collected RBCs are washed, filtered, suspended in saline, and returned to the patient. (Page 4)
- These inhibit fibrinolysis by their action at the active sites on plasminogen, inhibiting the activation of plasmin. TXA should be used prophylactically in major surgery where perioperative blood loss is predicted to be high. TXA has been shown to significantly reduce perioperative blood loss. The clinical randomization of an antifibrinolytic in significant haemorrhage (CRASH-2 trial) highlighted the benefit of early therapy with TXA in trauma induced bleeding. A significant decline in risk of death from haemorrhage with the early use of TXA in the trauma setting has been demonstrated (Page 5)
- In most surgical specialties, the use of postoperative drains is being reduced, often as a component of enhanced recovery after surgery programmes. The use of drains has been shown to increase blood transfusion rates in orthopaedic surgery. (Page 5)
- A single unit blood transfusion policy reduces transfusion rates and improves the economics of blood transfusion (Page 6)