Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- SECTION 3 System Management in Cardiothoracic Critical Care
- 3.1 CARDIOVASCULAR SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.2 RESPIRATORY SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.3 RENAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.4 HAEMATOLGY AND TRANSFUSION IN CARDIOTHORACIC CRITICAL CARE
- 31 Transfusion
- 32 Blood conservation strategies
- 33 Haematological diseases
- 34 Heparin-induced thrombocytopenia
- 3.5 GASTROINTESTINAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.6 IMMUNE SYSTEM AND INFECTION IN CARDIOTHORACIC CRITICAL CARE
- 3.7 ENDOCRINE SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.8 NEUROLOGICAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
31 - Transfusion
from 3.4 - HAEMATOLGY AND TRANSFUSION IN CARDIOTHORACIC CRITICAL CARE
Published online by Cambridge University Press: 05 July 2014
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- SECTION 3 System Management in Cardiothoracic Critical Care
- 3.1 CARDIOVASCULAR SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.2 RESPIRATORY SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.3 RENAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.4 HAEMATOLGY AND TRANSFUSION IN CARDIOTHORACIC CRITICAL CARE
- 31 Transfusion
- 32 Blood conservation strategies
- 33 Haematological diseases
- 34 Heparin-induced thrombocytopenia
- 3.5 GASTROINTESTINAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.6 IMMUNE SYSTEM AND INFECTION IN CARDIOTHORACIC CRITICAL CARE
- 3.7 ENDOCRINE SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.8 NEUROLOGICAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
Summary
Introduction
Bleeding and the need for transfusion of allogeneic blood products are common during and after cardiothoracic surgery. Despite advances in operative techniques, approximately one third of elective coronary artery bypass grafting procedures require allogeneic blood. As a result, cardiac surgery alone accounts for 10% to 25% of all blood transfused per year within the United States. Although it may be life saving, transfusion of blood components also has associated risks. Before initiating allogeneic transfusion, the expected benefits of a transfusion must therefore be weighed against these risks.
Mechanisms of bleeding in cardiac surgery
A multitude of reasons explain why patients bleed in the context of cardiac surgery. Initially, it is helpful to characterize bleeding as either surgical or coagulopathic in nature. This distinction sounds simple, but is often difficult and is dependent on several factors, including patient characteristics, the operative procedure, surgical technique and the need for transfusion itself.
Surgical causes of excessive bleeding after cardiac surgery account for 50% to 70% of bleeding events. Suggested standard criteria that generally indicate surgical bleeding and mandate surgical exploration can be defined.
The presence of haemodynamic instability (e.g. tamponade) is also important in the decision-making process. In an effort to identify patients requiring surgical reexploration earlier, some units use a blood loss nomogram. This methods allows better visualization of bleeding trends and comparison with other patients operated on at the same institution. Reexploration must be considered if haemorrhage rate crosses several centile lines, or if the blood loss exceeds the 95th centile for two consecutive hours.
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- Core Topics in Cardiothoracic Critical Care , pp. 239 - 246Publisher: Cambridge University PressPrint publication year: 2008