Masui. The Japanese journal of anesthesiology
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The present article reviewed the management of coagulopathy in the perioperative setting, following the Japanese practical guidelines for the blood component therapy, edited by the Ministry of Health, Labour and Welfare of Japan in 2005. The threshold concentrations of platelets, prothrombin time international normalized ratio (PT-INR) and activated partial thromboplastin time (APTT) were optimized for the perioperative critical care under active and/or microvascular bleeding, based on currently available randomized controlled trials. ⋯ Platelet counts, PT, APTT, and if possible, other point-of-care testing including thromboelastography and its modified techniques should be performed following visual inspection of abnormal bleeding. The transfusion algorithms based on causal diagnosis of coagulopathy optimize the risk/ benefit ratio of perioperative transfusion therapy.
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Careful assessment of risks and benefits has to precede each decision on allogenic red blood cell (RBC) transfusion. Physicians work to establish more appropriate transfusions of blood components according to the guidelines issued by the Ministry of Health, Welfare, and Labor in Japan. For many years the so-called "10/ 30 rule" was used as a hemoglobin/hematocrit transfusion trigger. ⋯ Therefore, transfusion decisions should be primarily based on an individual patient's need for global and regional oxygen supply as indicated by signs of inadequate global and regional oxygenation. However, a hemoglobin transfusion trigger may be useful if matched with some other makers of inadequate tissue perfusion. Therefore, RBC transfusion is recommended under the following circumstances: for hemoglobin levels < 6 g x dl(-1) and for physiologic signs of inadequate oxygenation.
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The current efforts and strategies have greatly helped reduce transfusion-associated risks. Indeed, the risk of being infected by a contaminated blood unit today is lower than that thirty years ago. ⋯ Compatibility testing is designed to ensure that the patient receives the intended units of red cell concentrate (RCC) and that transfusion will be effective with minimum risk of adverse reactions. The process includes ABO and Rh typing of patients, testing recipient serum for clinically important alloantibodies, and crossmatching donor red cells with recipient serum by a technique that detects serological incompatibility.