The long and winding road of acute normovolemic hemodilution

Shander, Aryeh; Perelman, Seth I.

doi:10.1111/j.1537-2995.2006.00888.x

Cited by 17 publications

(7 citation statements)

References 26 publications

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“…1). Early management of anemia and optimization of iron stores, management of bleeding risk factors, meticulous surgical techniques and hemostasis, use of hemostatic devices and agents, limiting phlebotomy, autologous cell salvage and acute normovolemic hemodilution [6,7], and measures for optimizing cardiovascular status and pulmonary function are some of the modalities of PBM. In the emergency or trauma setting, when there is little time for patient optimization, aggressive application of the intra-and postoperative principles are employed [8,9].…”

Section: How Pbm Work and Why It Is Different From The Concept Of Apmentioning

confidence: 99%

Five Drivers Shifting the Paradigm from Product-Focused Transfusion Practice to Patient Blood Management

2011

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The objective of this paper is to introduce clinicians and health care professionals to the concept of patient blood management (PBM) and to explain the difference between PBM and the concept of "appropriate use" of blood products. The five reasons why modern health systems need to shift from product-focused transfusion practice to PBM are also presented. These are: the aging population with a leveraged demand for blood products opposed to a shrinking donor base; the growing awareness that transfusion is a complex service involving many different cost centers within a hospital and representing a multiple of the blood product cost; the continuous effort to protect blood pools from known, new, or re-emerging pathogens while facing uncertainty over their potentially long silent carrier states; the emerging evidence that transfusion is an independent risk factor for adverse outcomes; and finally, a lack of evidence for benefit of transfusion for the vast majority of recipients. The Oncologist 2011;16(suppl 3):3-11

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Section: How Pbm Work and Why It Is Different From The Concept Of Apmentioning

confidence: 99%

Five Drivers Shifting the Paradigm from Product-Focused Transfusion Practice to Patient Blood Management

2011

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“…In theory, this practice should reduce the need for allogeneic transfusion. 59 ANH has several advantages over PAD in terms of time, cost, and convenience. It can be done in both elective and emergency procedures, and since the ANH blood units are collected in the operating room and kept by the patient's bed, administrative costs and risks of clerical errors are almost completely eliminated.…”

Section: S44mentioning

confidence: 99%

“…It can be done in both elective and emergency procedures, and since the ANH blood units are collected in the operating room and kept by the patient's bed, administrative costs and risks of clerical errors are almost completely eliminated. 59 Although studies have shown mixed results on the efficacy of ANH in reducing allogeneic transfusion, 60 it has been suggested that ANH would be effective in reducing transfusion only in surgeries with significant blood loss. 61 ANH remains a low-cost, useful tool in the armamentarium of blood conservation.…”

Section: S44mentioning

confidence: 99%

Sirolimus-Loaded Polyurethane Graft for Hemodialysis Access in Sheep

Shander

2008

Vascular

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Intimal hyperplasia is the most common final pathway for hemoaccess occlusion in dialysis patients. Drug eluting stents have been shown to decrease intimal hyperplasia in coronary arteries and possibly in peripheral arteries. We evaluated the use of a sirolimus loaded polyurethane graft as prophylaxis in hemodialysis access. Grafts were loaded with sirolimus and elution curves were determined for the polyurethane material. The arteriovenous grafts were then placed in the neck of 20 sheep. A non-loaded graft was placed in the contralateral neck. Patency rates, ultrasound evaluation, angiography and histomorphometry were determined for each graft. At 30, 60 and 90 days the drug loaded graft had improved patency rates compared to the control, with a 25% improvement noted at 3 months. Life table analysis showed the drug loaded graft consistently better patency than the control (p=.136). The control graft had greater neointimal stenosis (14.5% vs. 9.17%) over the course of the study (p=.157). Although none of these findings was statistically significant in this pilot study, the sirolimus coated graft out-performed the control in every measured parameter at each time point evaluated. Further work to asses the validity of drug coated materials to prevent intimal hyperplasia in hemodialysis access is warranted.

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“…Should a blood transfusion become necessary (or at wound closure), the patient's autologous blood is infused back to provide a fresh source of blood cells and coagulation factors. 38 ANH is effective in reducing transfusion requirement, especially in surgeries with anticipated large blood loss. Furthermore, it can provide an equivalent of 1-2 units of blood.…”

Section: Control Of Bleedingmentioning

confidence: 99%

What to do if no blood is available but the patient is bleeding?

Mackenzie

Shander

2008

Southern African Journal of Anaesthesia and Analgesia

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Background The dilemma of what to do if blood is unavailable (or in very short supply) when a patient is bleeding heavily has confronted all clinicians who work in the pre-hospital setting, operating room, intensive care unit or emergency department. This article reviews methods that are currently available and under investigation for bleeding control and resuscitation, including artificial oxygen carriers (AOCs), tourniquets, elevation/gravity, pro-coagulant technologies, haemostatic agents and minimisation of further blood loss by non-operative and minimally invasive surgical interventions. Methods The MEDLINE literature database, textbooks and the authors' 56 combined years of experience in anaesthesia, critical care and bloodless medicine associated with the Shock Trauma Center, Baltimore, Maryland, the Englewood Hospital and Medical Center and other hospitals with major blood use were resorted to in evaluating the management strategies described.

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The long and winding road of acute normovolemic hemodilution

Cited by 17 publications

References 26 publications

Five Drivers Shifting the Paradigm from Product-Focused Transfusion Practice to Patient Blood Management

Five Drivers Shifting the Paradigm from Product-Focused Transfusion Practice to Patient Blood Management

Sirolimus-Loaded Polyurethane Graft for Hemodialysis Access in Sheep

What to do if no blood is available but the patient is bleeding?

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