Alternatives to Blood Products
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17 terms
Terms | Definitions |
|---|---|
 What are 5 strategies to minimize blood loss preoperatively and to decrease transfusion needs? | 1. don't pick a crappy surgeon or drunken anesthetist 2. stop clopidogrel (and/or aspirin) 4 days pre-op, correct coagulopathies (vitK deficiency?), and correct anemias 3. use pediatric tubes to minimize blood drawn for diagnostic testing 4. maximize nutrition, use iron supplements if low 5. accept lower preoperative Hb an HCT *perioperative HCT 20-22% usually NOT associated with incr morbidity or mortality **this rule does not apply to pts w/ cardiovasc problems or brain surgery |
| What are 2 specific surgical/specialized procedures that can be helpful in minimizing blood loss in some types of surgery? | 1. laparoscopic access 2. regional & hypotensive anesthesia (specialized anesthetic technique) |
| Why has autologous predonation fallen out of favor? | 1. risk of complications serious enough to require hospitalization during autologous donation is higher than previously appreciated 2. patients go into surgery more anemic *contraindicated in borderline HCTs unless on EPO 3. significantly more expensive 4. risk of receiving wrong unit not avoided (**** happens) 5. pts can't give enough blood to be useful 6. not accessible to many pts |
| What is the principle behind isovolemic hemodilution? | 2-4 units bld removed in OR just prior to surgery and replaced isovolumetrically with saline or albumin - any blood lost during surgery will be at lower HCT than would be lost if not diluted - the removed high HCT blood is retrasnfused after major blood loss - cheaper and probably safer than autologous predonation |
| What are some problems with isovolumetric hemodilution? | - poorly standardized - conflicting data as to efficacy - contraindicated in significant coagulopathic pts, HTN, renal dz, hepatic dz, cardiac dz, or pulmonary dz |
| What is intraoperative blood salvage? | - device that "washes" salvaged RBCs and returns the cleaned cells (avoids coagulopathy) - most suitable for high volume "clean" blood loss (vascular surf, some trauma) ** NOT suitable for tumors or bowel surg |
| What is a major draw back to intraperative blood salvage? | - software set up is very expensive |
| What is postoperative blood salvage? Good option? | - blood from chest tube drainage post cardiac surgery, knee/hip drainage etc - costly and usually little is salvaged - blood reinfused unwashed only having been thru a simple filter - issues of sterility and coagulopathy - questionable efficacy - Dr. Boshkov is NOT a fan of this technique |
| What are the functions and potential concerns of Erythropoietin and Darbepoietin? | Fx: growth factor that increases RBC production by BM - indicated to increase pre-op HCT if high blood loss is anticipated Concerns: expensive, increased thrombogenicity and increased mortality and tumor progression in some cancers |
| What are the uses and concerns of DDAVP (desmopressin)? | Uses: 1st choice tx of mild-mod hemophilia A & type 1 vWD and useful tx of platelet disfunction Concerns: - short duration of action - tachyphylaxis(an acute (sudden) decrease in the response to a drug after its administration) - hyponatremia from repeated post op doses in kids |
| What are the 2 fibrinolytic drugs discussed in lecture? | 1. Tranexamic acid 2. Epsilon AminoCaproic Acid |
| What is the indicated use and MOA of tranexamic acid? | - synthetic derivative of the amino acid lysine - It is used to treat or prevent excessive blood loss during surgery and in various other medical conditions - competitively inhibits the activation of plasminogen to plasmin - has roughly eight times the antifibrinolytic activity of Epsilon AminoCaproic Acid |
| What are the concerns for using the fibrinolytic inhibitors? | 1. only available drug is the least established in clinical use (EACA) 2. optimal dosing not established for any 3. possible potentiation of prothrombotic risk |
| What are 3 potential uses of prothrombin complex concentrates that are currently being investigated? | 1. trauma 2. cardiac surgery 3. urgent warfarin reversal |
| What are perfluorocarbons? | - compound that carries oxygen physically dissolved in solution, so best at high inspired O₂ concentrations (e.g. intraoperative use) - short t½ limits clinical utility |
| What blood products are unacceptable to the major it of Jehovah's witnesses? | 1. RBC 2. platelets 3. plasma 4. whole blood 5. granulocytes |
| What products are almost always or always accepted by Jehovah's witnesses? | 1. Epo (has trace amt of albumin) 2. DDAVP 3. antifibrinolytic agents 4. perfluorocarbons |
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