Vox sanguinis
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Randomized Controlled Trial
Rationalizing blood transfusion in cardiac surgery: preliminary findings with a red cell volume-based model.
Cardiac surgery, utilizing extracorporeal circulation, is associated with a heavy fluid load that may significantly depress haemoglobin concentration. Thus, considering haemoglobin alone may be an inaccurate method of replacing red cell volume loss. This study was designed to examine the impact on red cell transfusion of a red cell volume-based guideline. ⋯ Considering haemoglobin concentration alone may significantly overestimate the requirement for red cell transfusion in elective cardiac surgery patients.
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Despite the continuous efforts to increase the safety of blood components, red blood cell transfusions remain associated with some risks and side effects. Therefore, numerous techniques have been developed to decrease blood use, but they also carry risks and bear costs. ⋯ The development of the 'best strategy' consists of the selection of those techniques that are most appropriate to the local specific situation. It implies the establishment of a reliable system, collecting data both at the surgical team and at the medical level.
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Requirements for allogeneic blood transfusion (ABT) after total knee replacement (TKR) are still high (30-50%), and salvage of unwashed filtered postoperative shed blood (USB) may represent an alternative to ABT. We evaluated that patients are more likely to benefit of USB reinfusion after TKR. ⋯ Return of USB after TKR seems to reduce the need for ABT, especially in patients with preoperative Hb between 12 and 15 g/dl. There is little benefit of USB reinfusion for patients with preoperative Hb > 15 g/dl, whereas patients with preoperative Hb < 12 g/dl would probably benefit from the combination of USB with some other blood-saving method.
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The use of an autotransfusion device to wash blood of the incision site is increasing. After washing, this blood is retransfused without side effects caused by activated plasma factors and cell release products. This procedure could be extended to washing of donor blood, which may be particularly useful for red blood cells (RBCs) stored for more than 4 weeks that contain high concentrations of free haemoglobin, potassium, lactate and other metabolites. It is not known whether stored RBCs can withstand the cell washing procedure with the use of an autotransfusion device, while keeping their primary functions intact. The objective of this study was to determine the quality of RBCs, after cell washing in comparison to untreated RBCs. ⋯ Washing stored blood before transfusion may be of benefit, because the waste products are effectively removed from the stored RBC.