Limiting excessive postoperative blood transfusion after cardiac procedures.
Analysis of blood product use after cardiac operations reveals that a few patients (¾20%) consume the majority of blood products (>80%). The risk factors that predispose a minority of patients to excessive blood use include patient-related factors, transfusion practices, drug-related causes, and procedure-related factors.
Multivariate studies suggest that patient age and red blood cell volume are independent patient-related variables that predict excessive blood product transfusion after cardiac procedures.
Other factors include preoperative aspirin ingestion, type of operation, over-or underutilization of heparin during cardiopulmonary bypass, failure to correct hypothermia after cardiopulmonary bypass, and physician overtransfusion.
A survey of the currently available blood conservation techniques reveals 5 that stand out as reliable methods : 1) high-dose aprotinin therapy, 2) preoperative erythropoietin therapy when time permits adequate dosage before operation, 3) hemodilution by harvest of whole blood immediately before cardiopulmonary bypass, 4) autologous predonation of blood, and 5) salvage of oxygenator blood after cardiopulmonary bypass.
Other methods, such as the use of epsilon-aminocaproic acid or desmopressin, cell saving devices, reinfusion of shed mediastinal blood, and hemofiltration have been reported to be less reliable and may even be harmful in some high-risk patients.
Mots-clés Pascal : Chirurgie, Coeur, Homme, Transfusion, Sang, Epidémiologie
Mots-clés Pascal anglais : Surgery, Heart, Human, Transfusion, Blood, Epidemiology
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0512427
Code Inist : 002B25E. Création : 01/03/1996.