			Home About us Contact

Homologous Blood (homologous + blood)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Autologous or homologous transfusion in aortic surgery: randomized trial

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2001
F. Torella
Background: Aortic surgery often requires blood transfusion, which may cause complications and postoperative infection. Autologous transfusion was evaluated in a multicentre clinical trial. Methods: Some 145 patients undergoing elective aortic surgery in eight hospitals were randomized to either ,homologous' or ,autologous' transfusion, a combination of acute normovolaemic haemodilution (ANH) and intraoperative cell salvage. Homologous blood was administered when the haemoglobin concentration fell below 8 g dl,1. Results: Median (interquartile range (i.q.r.)) blood loss was 668 (400,862) ml or 17 (10,24) per cent of blood volume in aortobifemoral bypass, and 1120 (765,1700) ml or 24 (17,36) per cent in aneurysm repair (P < 0·001). Autologous transfusion reduced homologous blood requirements from a median (i.q.r.) of 2 (0,4) units to 0 (0,2) units (P = 0·008). Independent predictors of blood transfusion were homologous transfusion strategy (odds ratio (OR) 2·3 (95 per cent confidence interval 1·1,5·0); P = 0·03), low preoperative haemoglobin concentration (OR 3·7 (1·7,8·2); P < 0·001), prolonged surgery (OR 2·1 (1·0,4·8); P = 0·05) and blood loss (OR 3·0 (1·4,6·5); P = 0·007). Patients with a preoperative haemoglobin concentration greater than 13·5 g dl,1 and who lost less than 20 per cent of their blood volume rarely required transfusion. There was no significant difference between the groups in terms of morbidity, mortality and postoperative hospital stay. Conclusion: Autologous transfusion reduced the need for homologous blood in aortic surgery, but was useful only in patients with low haemoglobin levels or when blood loss exceeded 20 per cent of the blood volume. ANH alone is indicated for patients undergoing aortobifemoral bypass and in those with a higher haemoglobin level and blood volume. © 2001 British Journal of Surgery Society Ltd [source]

Minimising blood loss and transfusion requirements in hepatic resection

HPB, Issue 1 2002
Luke L Bui
Background Substantial blood loss and the requirement for blood transfusion remain major considerations for hepatic surgeons. We analysed the impact of a systematic protocol aimed at reducing intraoperative blood loss and homologous blood (HB) transfusion associated with hepatic resection. Methods Prospective clinical data were collected from 151 elective liver resections performed during the period between 1980 and 1999. Further data directly related to blood loss and anaesthesia were retrospectively collected from the anaesthetic intra-operative record. Strategies implemented in 1991 included preoperative autologous blood donation, low central venous pressure anaesthesia, aprotinin administration, ultrasonic dissection, hepatic vascular inflow occlusion and a Cell Saver. Blood loss and transfusion requirements were studied before and after the implementation of these strategies. Results There was no difference in the patient demographics, indications for operation or the scope of resections in the two time periods evaluated. Blood-saving strategies resulted in decreased estimated blood loss (4500 mL vs. 1000 mL p < 0.001). In addition, the number of patients requiring transfusion decreased (91.8% vs. 25.5% respectively, p < 0.001) and the mean number of units of HB transfusion was lower (13.7 vs. 2.3, p < 0.001). Morbidity and mortality were also decreased (57.1% vs. 25.5%, p < 0.001 and 10.2% and 4.9% p < 0.001, respectively). No complications directly referrable to low CVP anesthesia were identified. Conclusion Systematic implementation of strategies designed to control blood loss are effective and may reduce morbidity and mortality associated with hepatic resections. [source]

Nitric oxide (NO) modulation of PAF-induced cardiopulmonary action: interaction between NO synthase and cyclo-oxygenase-2 pathways

BRITISH JOURNAL OF PHARMACOLOGY, Issue 4 2001
Fulvia Fabi
To further investigate into the mechanisms of PAF-induced cardiopulmonary actions, we examined the effects of the nitric oxide synthase (NOS) inhibitor L -N, -nitro- L -arginine (L -NNA), of the specific cyclooxygenase-2 (COX-2) inhibitor NS 398, and of the combined presence of both COX and NOS inhibitors on the PAF responses in the heart lung preparation of guinea-pig (HLP). In HLPs perfused with homologous blood, dose-response curves for the haemodynamic and bronchial effects of PAF (1 , 32 ng) were carried out in the absence or presence of L -NNA (200 ,M). L -NNA caused an increase in the resting pulmonary arterial pressure (PAP) without affecting the other basal values, and strongly potentiated the bronchoconstriction and pulmonary hypertension elicited by PAF. An enhancement of the PAF-induced actions on right atrial pressure (RAP) and cardiac output (CO) was also observed. All the effects of L -NNA were antagonized by L -arginine (2 mM). The presence of L -NNA in the perfusing blood of HLPs failed to affect the pulmonary hypertensive and bronchoconstrictor responses induced by the thromboxane A2 mimetic U46619 (0.05 , 1.6 ,g), 5-hydroxytryptamine (0.1 , 1.6 ,g), and histamine (0.1 , 1.6 ,g), thus suggesting that these PAF secondary mediators are not responsible for the hyper-responsiveness to PAF induced by L -NNA. Blocking COX-2 pathway with NS 398 (15 , 30 ,M) did not alter the cardiopulmonary resting variables. However, a reduction of the PAF-mediated pulmonary hypertension, but not of bronchoconstriction, was observed. When L -NNA was added to the perfusing medium of HLPs pre-treated with NS 398 or with indomethacin (15 ,M), the basal PAP values were enhanced. However, in the combined presence of COX and NOS inhibitors, only a slight increase in the hypertensive responses to the highest doses of PAF was observed, whereas the PAF mediated actions at bronchial and cardiac level were unaffected. This study indicates that (i) the cardiopulmonary actions induced by PAF are specifically modulated by endogenous NO through the NOS pathway, and (ii) COX-2 isoform is involved in the pulmonary hypertensive, but not bronchoconstrictor, effects of PAF. Furthermore, an interaction between PAF stimulated COX, particularly COX-2, and NOS pathways appears to take a functional role at both bronchial and cardiovascular level. British Journal of Pharmacology (2001) 134, 777,788; doi:10.1038/sj.bjp.0704311 [source]