Blood conseravtion stratergies during Cardiopulmonary bypass explained in short.

1. BLOOD CONSERVATION STRATERGIES
DURING CARDIAC SURGERIES
HABADE TEJASWINI DEEPAK.
3rd Year B.Sc. Perfusion Technology

2. INTRODUCTION :-
 Blood conservation is based on principle of avoiding allogenic blood
transfusion with aim of improving outcomes & protecting patient’s
rights.
 Blood conservation techniques also aim to lower the ‘ Transfusion
Trigger’, optimize the HCT, minimizing blood loss & optimize tissue
oxygenation.
 Blood conservation is essential as Cardiac surgeries are associated
with excessive bleeding as compared to Non cardiac surgeries.

3. BLOOD AND ITS COMPONENTS:-

4. PRINCIPLE’S FOR RED BLOOD CELLS & FRESH FROZEN
PLASMA (FFP) TRANSFUSION :-
RED BLOOD CELLS:-
 Red blood cell’s transfusion is
one of several alternative
therapies for patients with
clinically significant anaemia.
 Administration of packed
red cells can be done to
prevent or minimize the
onset of symptoms of
hypoxia.
PLASMA (FFP) :-
 Active bleeding as a result of
multiple coagulation factor
deficiencies or risk of
bleeding due to deficiency of
multiple coagulation factor.
 It is also administered if there
is deranged PT, ACT, etc.

5. NORMAL COAGULATION CASCADE

6. BLOOD CONSERVATION STRATERGIES
 PRE OPERATIVE
 INTRA OPERATIVE
 POST OPERATIVE

7. PRE OPERATIVE
 Anticoagulants must be stopped 4-5 days prior to the surgery day
 Drugs inhibiting Platelet activities should be discontinued.
 Correction of hemoglobulin levels should be corrected.
 Autologous Pre operative blood donation before surgery for
recombinant human erythropoietin for considering to restore RBC’s
volume.
AUTOLOGOUS BLOOD REMOVAL :
 This method eliminates risk of diseases of Transmission & cross matching
errors.
 It is beneficial in patients having multiple RBC’s antibodies or unusual
blood phenotypes.
DRUGS :-
• Aprotinin – Reduces bleeding during surgeries.

8. INTRA OPERATIVE
 RETROGRADE AUTOLOGOUS PRIMING :-
 Introduced to reduce heamodilution due to circuit priming with priming
fluids used like Plasmalyte, Ringer lactate, etc.
 Controlling all pressures of patient & regional anesthesia.
 Use of Ultrafiltration :-
 Zero- balanced Ultrafiltration.
 Conventional Ultrafiltration.
 Modified Ultrafiltration.

9. ZERO – BALANCED ULTRAFILTRATION ( Z-BUF)
• Z-BUF functions like hemofiltration by removing plasma water, the amount
of water removed is in excess of what is necessary to be reversed
hemodilution & is replaced with a balanced electrolyte solution.
CONVENTIONAL ULTRARILTRATION (CUF)
• It is a technique which is used to eliminate large amount of excess fluid
while the pt is on cpb depending on the HCT and venous reservior level.
MODIFIED ULTRAFILTRATION (MUF)
• It is technique done after termination of bypass but before administration of
Protamine.
• It provides known advantages specially in peadiatrics with improvements in
heamodynamic, Pulmonary, Coagulation and other organ functional.
Theraby decrease in BT , Reduction in Total body water and blood loss
post operative.
• It is performed for 10-20mins at the rate of 10-15/kg/min.

10. MODIFIED ULTRAFILTRATION CIRCUIT

11. CELL SAVAGE
• This method is used to help in recovering patient own blood loss
during surgeries & post operative phase.
• Viral infections of hemodynamics , Bleeding time can be minimized
by this method.

12. TO BE CONSIDERED AS GOOD PRACTICE WHILE
SURGERY
 VACCUM ASSISTED VENOUS DRAINAGE.
 MICROPLEGIA
 USE OF CUSTOMISED CARDIOPLEGIA
 MINIMIZED CIRCUIT
 USING LESS PRIMING FLUIDS
 AVOIDING EXCESSIVE USE OF DRUGS

13. BLOOD TRANSFUSION REACTIONS

14. FNHTR – Fibrile Non Heamolytic Transfusion Reaction
TRALI – Transfusion Related Acute Lung Injury
TACO- Transfusion Associated Cardiac Overload
GVHD – Graf Versus Host Disease
PTP – Post Transfusion Purpura
DHTR – Delayed Heamolytic Transfusion Reaction

15. POST OPERATIVE
DRUGS
1. Tranxemic Acid – Antifibrinolytics
2. Aminocarproic Acid – Enzyme Inhibitor
3. Traylol – Serum Protease Inhibitor
4. Thrombophob – Superficial Thrombophlebities

16. THANKYOU…