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Chapter 82 - Patient Blood Management

from Section 10 - Emergency Events

Published online by Cambridge University Press:  03 August 2023

By
Jennifer Eismon
Edited by
Jessica A. Lovich-Sapola
Jessica A. Lovich-Sapola
Affiliation:
Cleveland Clinic, Ohio
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Summary

A 73-year-old female, following a motor vehicle collision, is scheduled for an urgent spine open reduction internal fixation (ORIF) due to a Chance fracture sustained while wearing a lap belt. Her medical history consists of congestive heart failure (ejection fraction is 35%), atrial fibrillation on warfarin (Coumadin) (current INR 3.1), iron deficiency anemia (hematocrit 27), and thrombocytopenia (platelets 78). She also takes aspirin 81 mg. How will you reverse the warfarin for surgery? How will you manage her anemia? Will you transfuse her prior to the surgery? What management strategies will you institute if blood loss is expected to be high? What if she refuses blood transfusion?

Type
Chapter
Information
Anesthesia Oral Board Review
Knocking Out The Boards
 , pp. 342 - 346
Publisher: Cambridge University Press
Print publication year: 2023

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References

American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology 2015;122:241–75.Google Scholar
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Gropper, M. Miller’s Anesthesia, 9th edition. Philadelphia: Elsevier, 2020, pp. 1579–602.Google Scholar
Hohmuth, B, Ozawa, S, Ashton, M, et al. Patient-centered blood management. J Hosp Med 2014;9:60–5.CrossRefGoogle ScholarPubMed
Johansson, PI, Ostrowski, SR, Secher, NH. Management of major blood loss: an update. Acta Anaesthesiol Scand 2010;54:1039–49.CrossRefGoogle ScholarPubMed
Shander, A, Javidroozi, M. Blood conservative strategies and management of perioperative anemia. Curr Opin Anaesth 2015;28:356–68.CrossRefGoogle Scholar
Shander, A, Van Aken, H, Spahn, D. Patient blood management in Europe. Br J Anaesth 2012;109(1):55–68.CrossRefGoogle ScholarPubMed
Tanaka, KA, Esper, S, Bollinger, D. Perioperative factor concentrate therapy. Br J Anaesth 2013;111(S1):i35–i49.CrossRefGoogle ScholarPubMed

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