Packed Red Cells in Acute Blood Loss

Abstract

The purpose of this study was: 1) to define coagulation abnormalities in patients who receive red cell concentrates rather than whole blood for large volume blood loss (greater than 0.5 blood volume); and 2) to determine when coagulation abnormalities lead to increased bleeding in the massively transfused surgical patient. We studied 32 ASA physical status I or II patients (mean age 15.6 +/- 2.3 yr) who lost more than 50% of their blood volume during elective posterior spinal stabilization. Crystalloid solutions and packed red cell concentrates were used to replace blood and fluid losses. Invasive hemodynamic measures, urinary output, and serial hematocrit determinations were used to help maintain a constant intravascular volume and confirm the estimates of blood loss. The quality of hemostasis was assessed during operation. In 15 of the 32 patients, surgical hemostasis remained effective throughout posterior spinal fusion. A coagulation profile (prothrombin time [PT] and activated partial thromboplastin time [aPTT], platelet count, and fibrinogen) was measured at the conclusion of operation in these patients. In 17 patients, increased surgical bleeding as a result of decreased clot formation and increased bleeding from the wound was present. In these 17 patients at the time increased bleeding was diagnosed, hemostatic tests (PT, aPTT, fibrinogen, platelet count, and coagulation factor assays V, VIII, and IX) were obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormal Coagulation during Pediatric Craniofacial Surgery

“…Data from adults and adolescents indicated that dilution of clotting factors becomes important when blood loss approaches 1.5 times EBV. The PT and PTT generally reach 1.5–2.0 times control values and fibrinogen may decrease to 75–125 mg/dl [26, 27, 32]. These values are very similar to those of group A patients.…”

“…Fibrinogen and FVIII are acute phase reactants which complicates interpretation of their values. The clinical coagulopathy encountered can probably be explained as the summation of several mild factor deficiencies [27]. This interpretation is supported by the fact that PTT was the independent variable most significantly associated with blood loss.…”

“…Some reports involved shocked patients undergoing emergency surgery and it may be problematic to extrapolate findings to stable patients undergoing elective surgery [27]. Pediatric and adult studies demonstrated that platelet count declined logarithmically during massive whole blood transfusions [25, 33, 34].…”

“…We hypothesized that should abnormal hemostatis occur, the most likely causative mechanisms would involve one or more of the following: (1) hyperfibrinolysis [22]; (2) disseminated intravascular coagulation [23, 24], and (3) thrombocytopenia [25]and/or coagulation factor deficiency [26, 27]as a consequence of massive blood transfusion. The aim of our prospective study was to determine whether abnormal hemostatis occurs in children undergoing major craniofacial surgery and to characterize the nature of any coagulopathy found.…”

Peri- und intraoperative Gerinnungsstörungen und ihre Therapieempfehlungen

“…Die Verdünnungskoagulopathie ist ein seit Langem bekanntes, klinisch relevantes Phänomen, das vor allem bei Volumenersatz ohne Gerinnungsfaktoren zu beobachten ist [10]. Es kann allerdings auch bei der alleinigen Verwendung von Plasma (vor allem über längere Zeit) auftreten, da während der Produktion von gefrorenem Frischplasma (fresh frozen plasma (FFP)) ein Teil der Gerinnungsfaktoraktivität verloren geht; mit FFP alleine kann daher bei anzustrebender Isovolämie keine gegenüber dem Normalzustand isoaktive Konzentration an Gerinnungsfaktoren erreicht werden [11].…”