The document provides an overview of blood conservation strategies in perioperative patients. It discusses why blood conservation is important to conserve limited blood resources and reduce risks of transfusion. Key strategies mentioned include preoperative patient optimization, use of antifibrinolytics like tranexamic acid, controlled hypotension, cell salvaging, normovolemic hemodilution, and autologous blood donation and transfusion to avoid allogeneic transfusions and their associated risks. The document emphasizes a multidisciplinary team approach and utilization of the latest drugs, techniques and technology to minimize blood loss and reduce need for allogeneic blood transfusions in surgical patients.
DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar
This presentation deals with diabetes mellitus and its anaesthetic implications. All about preoperative investigations and intra-operative management are discussed.
Jehowah's witnesses and blood conservation strategies by Dr.Minnu M. PanditraoMinnu Panditrao
dr. Mrs. Minnu M. Panditrao explains the problems faced by anesthesiologists in anesthetising the Jehowah's Witness patients because of their beliefs. Ina ddition she also discribes various strategies of Blood conservation.
DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar
This presentation deals with diabetes mellitus and its anaesthetic implications. All about preoperative investigations and intra-operative management are discussed.
Jehowah's witnesses and blood conservation strategies by Dr.Minnu M. PanditraoMinnu Panditrao
dr. Mrs. Minnu M. Panditrao explains the problems faced by anesthesiologists in anesthetising the Jehowah's Witness patients because of their beliefs. Ina ddition she also discribes various strategies of Blood conservation.
These guidelines are very important in cardiac surgery. Tranfusion triggers, perfusion interventions,blood salvage,blood products all are described in great detail.
Manejo de la anemia perioperatoria basada en la evidencia
Charla en el Hospital Universitario Nuestra Señora de La Candelaria en Santa Cruz de Tenerife 30 de marzo de 2015.
Servicios de Hematología y Hemoterapia, Anestesióloga y Cirugía Digestiva
Choosing Wisely. Fast Track. Rehabilitación Mulltimodal
Can avoid many complication associated with allogenic transfusion
– Acute hemolytic reactions
– Allergic & febrile reactions
– Transmission of diseases
• Hepatitis – B
• AIDS
• Syphilis
• Malaria
• Conservation of blood resources
• Avoidance of immunosuppressive effects of allogenic transfusion
• Patient’s with rare blood group are particularly benefited by these
techniques
• It allows the availability of fresh whole blood for transfusion3 different techniques available
– Pre-operative blood donation
– Acute normo-volaemic heamo-dilution
– Intra & post-operative blood salvage
• Advantages, applications & complications
vary with each techniqueAny patient with an adequate haemoglobin level(11g)
– A patient weighing 50 Kg, Hb >11gm & Hct> 33% can
donate 450 ml of blood safely. Those with lesser body
weight can donate proportionately lesser volume
• Adolescents & children below 10 years also can be a
candidate if he is cooperative
• Elderly patients can safely donate
• Obstretric patients – no adverse effects for mother & baby
are reported
• A history of Hepatitis-B or AIDS is not a contraindication
• Unstable angina, severe CAD, severe aortic stenosis are
considered as contraindicationsSeparately labeled as Autologous with the patient’s name
and ID number
• ABO & Rh typing is also done and labeled which will help
in patient’s identification
• Screening for Hepatitis B and AIDS are not mandatory
• No cross matching is required
• If CPDA-1 is used as preservative the blood can be stored
as whole blood for 35days
• Separation into plasma and Rbc increases the shelf life to
42 days
• If more storing is required the RBC can be frozen and
storedProvides fresh whole blood for transfusion.
• No biochemical alterations associated with
storage.
• Removed blood is kept in the OR in room
temperature, so no chance of hypothermia
• Platelet function is preserved
• No reduction in oxygen carrying capacity
• RBC loss during surgery is less as it is diluted
with asanguinous fluid
• Haemodilution decreases blood viscosity , which
improves tissue perfusionBlood is withdrawn from a central or peripheral
vein or radial artery.
• Blood is collected in standard blood bags
containing CPD.
• Crystalloid and or colloid are infused as blood is
withdrawn.
– Crystalloid = 3 times the volume of blood removed
– Colloids = Equal to the volume of blood removed.
– Dextran ,albumin , Heta-starch, No significant
differences
– Crystalloids have the advantage of easily excreted by
a diuretic at the time of re-infusion• With the use of special equipments the blood is
collected from the operative field and draining
sites.
• Recovered blood is mixed with anticoagulant is
collected in a reservoir with a filter.
• The filtered blood is then washed with saline. The
RBCs suspended in the saline are then pumped
into a re-infusion bag.
• Most of the WBCs, platelets, clotting factors, cell
fragments and other debris are eliminated.
• Several automated devices are available for use,.HCT of process
Current Component Therapy by Diane Eklund, MDbloodbankhawaii
Lorem ipsum dolor sit amet, voluptaria percipitur has eu. Nibh iriure nostrud ei mea. Vel dicta voluptua convenire ei, id pro libris viderer. Pri et legendos atomorum, vel eu noster probatus menandri. Omnes possim ut eam, sed ea labore maiorum.
Surgery resident postgraduate presentation on the use of blood and products presented dept of surgery, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. Do we feel that a transfusion
is an organ transplant ?
3. Session Objectives
• Provide an overview of blood
conservation in perioperative patients
What is it?..
Why is it important?..
How is it accomplished?..
4. SABM, 2007
What is Blood Conservation?
• Blood Conservation: Society for
the Advancement of Blood
Management (SABM)
‘team
approach to surgical patient
care that utilizes the latest
drugs, technology and
techniques to enhance a
patients own blood supply and
decrease blood loss …the aim
is to reduce or avoid the
need for transfusion’
5. Why do we need
blood…?
• For O2 transport…?
• O2 Content =
Hb*1.37*SaO2 + 0.0034*PaO2
• At Hb 4.7 g/dl O2 delivery reduces by 30%
(Liberman JA. Anesthesiology 2000; 92.)
• Upto 40% permissible loss( approximately
2L in males) (Herbert PC. NEJM 1999; 340)
6. ASA task force guidelines 1996
• Transfusion is rarely indicated when the
hemoglobin level is above 10 g/dL
• Almost always indicated in patients when the
hemoglobin level is below 6 g/dL;
• For hemoglobin level 6-10 g/dL
– Ongoing indication of organ ischemia,
– The rate and magnitude of any potential or actual
bleeding,
– The patient’s intravascular volume status
– Risk of complications due to inadequate oxygenation.
• Use Blood Components separately
• Promote blood conservation
7. O'Brien et al , 2007
Infectious and Non Infectious risks
• 1 in 100 – minor allergic reactions
– rash etc
• 1 in 300 – febrile non-hemolytic
reaction to RBC
• 1 in 700 – transfusion related
circulatory overload
• 1 in 5,000 – Transfusion Related
Acute Lung Injury (TRALI)
• 1 in 10,000 – Symptomatic
bacterial sepsis from platelet
transfusion
• 1 in 40,000 – death from bacterial
sepsis - platelet transfusion
• 1 in 40,000 – ABO incompatible
transfusion per RBC transfusion
• Coagulopathy
•1 in 40,000 – serious allergic
reaction per unit of component,
anaphylaxis
•1 in 82,000 – transmission of Hep B
virus
•1 in 100,000 – bacterial sepsis per
unit of RBC
•1 in 500,000 – death from bacterial
sepsis per unit of RBC
•1 in 1,000,000 – WNV
•1 in 2,300,000 – Hep C
transmission
•1 in 7,800,000 – HIV transmission
•Post Transfusion Purpura
10. Is Blood Transfusion
safe…when you can prevent it?
• Patient safety
• Informed choice for patients
• Resource allocation
• Infectious risks
• Non-infectious risks
• Blood products are a scarce
resource
• Blood is expensive!
11. Blood Conservation – Why?
• Conserve blood resources
– Regional blood centers find it increasingly difficult to
collect sufficient blood to meet patient needs in many
areas of the country.
– In the next 15-20 years the number of patients >65
y.o. will more than double but the number of blood
donors will only marginally increase
– The number of units used nationwide is increasing 1%
per year, but the people donating is decreasing 1%
per year.
13. Blood Conservation…
Why perioperative patients?
• 50-70% of blood products used in
hospitals are used in the perioperative
setting (Hebert et al, 2004)
• Potential exists to modify some predictors
of transfusion in elective surgical patients
- Pre-op Hb, Blood loss
• Wide variation in transfusion practice for
procedures
14. How important is pre-op
Hemoglobin?
• A national (US) audit found that 35% of patients coming for
arthroplasty have Hb <130g/L
• UK study found that 20% of all patients in 1 year were anemic
males<130g/L, females <115g/L)
•GoodenoughGoodenough,, 20072007
•Karkouti et al 1999Karkouti et al 1999
•Saleh et al, 2007Saleh et al, 2007
16. Pre-op evaluation
Pre-op Hb optimization:
4-6 week lead time for assessment, screening and
appropriate interventions:
• Correction of nutritional anemia
iron therapy – dietary advice,supplements
Vit B12, Folate
• Careful attention to patient medical history, pre op meds
ASA, Clopidrogel (Plavix), NSAIDs, herbal
supplements
• Pre operative autologous donation
• Erythropoietin therapy (Karkouti et al, 2005)
• ? Delay surgery
17. METHOD TO REDUCE BLOOD
USE IN SURGERY
• PREOPERATIVE
* Surgery elective – Correct the Haemoglobin level.
Stop drugs that interfere
haemostasis.
• INTRAOPERATIVE
– Posture
– Use of Vasoconstrictors
– Use of tourniquets
– Use of anti-fibrinolytic drugs eg tranexamic acid
– Use of Aprotinine
– Controlled hypotension, Regional anaesthesia
• POST OPERATIVELY
– Blood can be salvaged from drains into collection
devices that permit reinfusion
18. Meticulous
Technique
• Careful, precise
procedures, using
natural tissue planes
• Planned vascular control
• Use of clips, ligatures, and cautery
where appropriate
• Newer techniques (harmonic scalpel,
LASER)
• NB. MINIMIZE BLOOD LOSS
20. Blood Substitutes
• Hb sol. (human, bovine) –
• Increases Hct
• systemic & pulmonary HTN
• Perflurocarbon emulsions –
• O2 solubility 20 times of plasma
• Decreases Platelets & require high PaO2
• Focus is on the ability to carry oxygen, not on
the other functions of blood
• Effective only for 12-24 hrs
• Good for short term till blood is arranged
21. Cell Salvage With Ultrafiltration
• ‘recycling’ of blood that
would otherwise be
discarded
• CV/ortho/trauma (Cochrane,
2006)
• Contraindicated in
malignancy,
contaminated wound
• RBC’s suspended in NS
• May be acceptable to
JW patient
Cell Saver
22. Cell Salvage
• The Hemobag® and its TS3 tubing set
allows for Ultrafiltration both during the
case and at the end for Whole Blood
Autotransfusion.
• The end product is a hyperoncotic
Autologous Whole Blood packed with viably
functioning Platelets, Clotting Factors,
Albumin, Plasma Proteins and RBC’s with
no morbidity or side effects.
23. Isovolemic Haemodilution
• 1 to 2 units of patient’s blood withdrawn
at the beginning of a procedure
• Blood volume restored with
crystalloid/colloid solution
• Patient bleeds “thin blood” during
procedure
• Gets own blood back at the end
25. Why Autologous Blood
Transfusion
• Fully compatible blood.
• No risk of transfusion transmitted diseases
such as hepatitis, CMV and HIV infection.
• Avoidance of allo-immunization.
• Improved O2 perfusion by lowering blood
viscosity.
• Acute Normovolemic Hemodilution provides
fresh whole blood .
• Less dependant on the blood bank’s stock.
26. A marked reduction in the hospital infection
rates, antibiotic usage and length of hospital
stay in patients who received autologous blood
or no blood
Triulzi et al, Transfusion 1992;32:517-524;
Forgie et al, 1998
Why Autologous Blood
Transfusion
•Readily available in major haemorrhage
•Avoidance of immuno-suppression
27. Criteria
• Age: less than 65 year old
• Hb: at least 11.0g/dl
• Weight: at least 50kg
• No h/o severe heart and lung disease,
abnormal bleeding tendency
• No bacteraemia at time of donation
• No h/o hepatitis B/C or HIV
• Cancer not a contraindication
28. Pre-surgical Autologous Blood Donation
• Best choice for patients with rare blood types or
irregular antibodies.
• One unit per week & takes Fe/EPO.
• Then donates 1 unit per week (usually no more
than 3 or 4 units)
• Last donation must be at least 72 hrs before
operation.
• Blood is stored and kept for patient for re-
infusion during/after operation.
29. Labeling and Storage
• Carefully designed system.
– Special procedure code
– Autologous stamp.
– Detail of place and date of operation.
• Special and distinct label on blood pack.
• Autologous donor card with unit number on it.
• Stored in different site.
30. Should Autologous Blood be
“made homologous”?
The American Medical Association,
AABB, NBS discourage the
“crossover” of unused autologous
units to the general blood supply.
• Liberal eligibility criteria.
• Safety concerns.
• Legal liability
31. Role of Erythropoietin in
Autologous Transfusion
• Allow more units to be collected.
• Need two to more weeks to work.
• Expensive.
32. Points to consider
• Cost
• Surgeon and Anaesthetist
enthusiasm
• Availability of allogeneic blood
• Which types of procedures: “ortho;
intestinal; clean operations”
• Public awareness
33. • Remember that transfusion of any
Allogeneic blood or blood products is
an “Organ Transplant", and not just
another medication that is without
side-effects. Treat everyone like a JW !
End of starting…..
34. Transfusion Algorithm
• Avoid Transfusion : medical and surgical
• Alternatives
replacement fluids: crystalloids and non
plasma colloids over plasma
pharmacologic agents to reduce bleeding
• Autologous donation
• Minimize exposure to allogeneic
transfusion
35. Thought for the day……
“Blood transfusion is a lot like
marriage. It should not be
entered into lightly,
unadvisedly or wantonly, or
more often than is absolutely
necessary.”
Beal, RW, 1976Beal, RW, 1976
Beal RW, 1976Beal RW, 1976
37. Tranexamic Acid
• Mechanism of Action:
• Forms a reversible complex that displaces plasminogen from fibrin resulting
in inhibition of fibrinolysis; it also inhibits the proteolytic activity of plasmin
• Dose Children and Adults: I.V.: 10 mg/kg immediately before surgery, then
25 mg/kg/dose orally 3-4 times/day for 2-8 days
• Dosage modification required in patients with renal impairment; ophthalmic
exam before and during therapy required if patient is treated beyond several
days; caution in patients with cardiovascular, renal, or cerebrovascular
disease; caution in patients with a history of thromboembolic disease (may
increase risk of thrombosis); when used for subarachnoid hemorrhage,
ischemic complications may occur
• Adverse Reactions:
• >10%: Gastrointestinal: Nausea, diarrhea, vomiting
• 1% to 10%: Cardiovascular: Hypotension, thrombosis
• Ocular: Blurred vision
• <1%: Unusual menstrual discomfort
• Postmarketing and/or case reports: Deep venous thrombosis (DVT),
pulmonary embolus (PE), renal cortical necrosis, retinal artery obstruction,
retinal vein obstruction, ureteral obstruction
Blood Conservation is one element of a patient centred blood management philososphy. SABM defines this element as “team approach…
Potential candidates for transfusion are include patients undergoing large surgeries, in which a significant amount of blood loss can occur. Patients who have blood disorders or acquired deficiency secondary to massive bleeding may also require blood products, as well as patients who are critically ill. But keep in mind, that a liberal transfusion approach, as was reviewed earlier, is fraught with negative outcomes.
Many recommendations for improvemnet in our blood supply canme as a result of the Commision of Inquiry in 1997.The tainted blood scandal of the 1980’s was, in the words of Justice Horace Krever, the worst public health tragedy in Canada’s history.It was also the catalyst for many of the current hemovigilance and blood management initiatives currently in place, as well as the growing body of literature informing us about the risks associated with transfusion. in his final report to the Canadian Government He made many recommendations for improvement at all levels from the blood supplier to the health care providers concluding that ,even if all of these changes were realized, that blood transfusion will never be zero risk and that the precautionary principle should always apply with respect to transfusion.
The Ontario government is committed to funding programs that ensure safe transfusion practice in addition to promoting appropriate use of alternatives to transfusion wherever possible.
ONTraC and ORBCoN are 2 such initiatives, currently funded and under the direction of the BPCO which was formed in 2005