Erythropoitin and total joint replacement
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The document discusses strategies to reduce blood loss and transfusion requirements during total hip and knee replacement surgeries. It notes that average blood loss is 1.5 liters for THR and TKR but hidden blood loss accounts for 26-50% more. Revision surgeries have even higher blood loss. Options discussed to reduce transfusions include preoperative autologous blood donation, blood conservation measures, use of erythropoietin to increase hematocrit levels preoperatively, and hemostatic agents. Risks of transfusions include errors, infections, increased costs and length of stay.
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Fluid manage 최종[1]
1. Maintaining adequate oxygen delivery to tissues is important for shock patients. This involves optimizing factors like cardiac output, hemoglobin, and oxygen saturation through fluid resuscitation and vasopressor support if needed.
2. Hypovolemic shock results from a loss of intravascular volume that exceeds 15% of total blood volume. Rapid volume replacement is critical to restore tissue perfusion and prevent end-organ damage.
3. Crystalloids and colloids can both be used for initial fluid resuscitation in bleeding shock, with colloids being more effective at expanding plasma volume. Albumin, hetastarch, and gelatin are options for colloid fluid resuscitation.
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The document discusses bridging devices to transplant for acute liver failure. It describes two scenarios for liver failure - acute liver failure where liver function was normal prior, and acute on chronic liver failure where there was pre-existing liver damage. It summarizes different artificial liver support systems including bioartificial and non-biological systems. It provides details on albumin dialysis using MARS and compares its effects to the Prometheus liver support system.
Blood bank
This document discusses the rational use of blood and blood products at the Queen Elizabeth Hospital (QEH) blood bank. It provides an overview of the various blood components available from donations, including packed red cells, platelets, fresh frozen plasma, and cryoprecipitate. It also examines current usage of blood products at QEH, problems faced by the blood bank like low donor numbers and equipment issues, and makes recommendations to improve blood product usage such as increasing donor awareness, expanding mobile clinics, and reducing unnecessary transfusions.
Fluid-and-Electrolyte-ppt1-by-Dr.-Mohsin (1) (1).pdf
The document discusses fluid and electrolyte balance in the human body. It provides details on:
- The breakdown of total body water between intracellular fluid, extracellular fluid, intravascular fluid, and interstitial fluid.
- Signs and symptoms of various fluid and electrolyte imbalances including dehydration, hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hypomagnesemia, and electrolyte imbalance.
- Causes, treatments, and normal ranges for various electrolytes including sodium, potassium, calcium, magnesium, and phosphorus.
Cirrhosis Of Liver
This document discusses cirrhosis of the liver, including causes, histological types, clinical features, complications, investigations, management, and prognosis. Cirrhosis results in prolonged morbidity and premature death. Common causes include alcohol, viral hepatitis, and genetic conditions. Complications include portal hypertension, ascites, hepatic encephalopathy, and hepatocellular carcinoma. Management involves treating the underlying cause, managing complications, and liver transplantation in severe cases. Prognosis depends on liver function, with 50% surviving 5 years if function is good.
Body Fluid and Compartments | DR RAI M. AMMAR | ALL MEDICAL DATA
Body Fluid and Compartments | DR RAI M. AMMAR | ALL MEDICAL DATA
by DR RAI M. AMMAR
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Intraoperative acetabular fracture and pelvic discontinuity in thr
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Pelvis acetabulum - anatomy , imaging , classification
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Revision thr indication, investigation & preparation
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Erythropoitin and total joint replacement
- 1. Dr. Jatinder S. Luthra
- 2. None
- 3. Average 1 – 1.5 litres Appreciated and replaced
- 4. Average blood loss after THR 1.5L Hidden loss 470ml ( 26%) Average blood loss after TKR 1.5L Hidden loss 765 ml ( 50 %)
- 5. Revision Hip surgeries – 2.5L – 3.0 L Cementless TKR – Higher blood loss B/l TKR
- 6. Allogenic Blood transfusion Preoperative Autologous blood Donation Blood conservation measures
- 7. Primary THR – 2.0 ( +/- 1.8) Revision THR – 2.9 ( +/- 2.3) Bae et al Arthroplasty 1999 Primary TKR – 1-2 units Revision TKR – 3-4 units
- 8. Pre op Hb - < 10g - 90 %
- 9. Weight Age Aspirin Female Comorbidities B/L TKR
- 10. Risks of Blood Transfusion Clerical error Bacterial contamination Increased length of stay Immunomodulation Cost
- 11. 1-2 units – primary joint replacement 4-6 units – revision joint replacement Hb > 11gm 5-7 days interval ( last unit 3 days before surgery)
- 13. Scheduling difficulties Limited shelf life Clerical errors Bacterial contamination
- 16. Perioperative blood salvage Haemodilution Intraop Pharmacologic agents Increased Haematopoiesis
- 17. Preop blood donation Post op Blood transfusion Blood lost intraop lower haematocrit
- 18. TOPICAL AGENTS SYSTEMIC ANTIFIBRINOLYTIC Thrombin Desmopressin Fibrin glue Aprotinin Collagen Tranexamic acid Epinephrine sponges E-aminocaproic acid Bone wax
- 20. ERYTHROPOIETIN
- 21. Glycoprotein hormone Secreted by Kidneys (Peritubular cells) Acts on RBC progenitors
- 22. Alex Schwazer Increases oxygen Italian Race walker delivery Endurance sports Cycling Boxing Athletics Rowing
- 23. LANCE ARMSTRONG
- 26. 50% 40% 30% 20% Blood transfusion 10% 0% Placebo 20000EPO 40000 EPO
- 27. Blood Transfusion 60% 40% 20% Blood Transfusion 0% Placebo EPO
- 29. 40% 30% 20% Blood transfusion 10% 0% EPO PAD EPO +PAD
- 30. 30% 25% 20% 15% Blood Transfusion 10% 5% 0% EPO PAD
- 31. Dose – 40,000 IU ( 600IU/Kg) Augmented with iron supplementation In most studies drug is indicated for preop anemia in range of 11g to 13g
- 32. Increased risk of Thromboembolic Events
- 38. Level A evidence to recommend use of Erythropoietin before major orthopaedic procedure FDA approved drug before major orthopaedic surgeries NICE guideline recommend EPO only for anemia associated with Ca and renal disease Most studies the Pre op Hb level was 11g to 13g Extremely useful in patients with rare antibodies in blood, Jehovah witness ! Post Op anemia is not corrected by Erythropoietin !!!
- 39. THANK YOU
- 40. Exacerbation of hypertension ? Best effect in patients with Hb 10 – 13 Below Hb 10 Erythropoitin is already secreted unless renal failure