Ebook Millers textbook (8/E): Part 4
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Ebook Millers textbook (8/E): Part 4
Chapter 63Patient Blood Management: Autologous Blood Procurement, Recombinant Factor Vila Therapy, and Blood utilizationLAWRENCE T. COODNOUCH • TERRI Ebook Millers textbook (8/E): Part 4 G. MONKKey Points•The two primary reasons for employing autologous transfusion are avoidance of complications associated with allogeneic transfusion and conservation of blood resources.•The three types of autologous blood transfusion are preoperative autologous donation (PAD), acute normovolemic he Ebook Millers textbook (8/E): Part 4modilution (ANH), and intraoperative and postoperative blood recovery (salvage).•PAD became accepted as a standard practice in certain elective surgicEbook Millers textbook (8/E): Part 4
al settings such as total joint replacement surgery, so that by 1992 more than 6% of the blood transfused in the United States was autologous. SubsequChapter 63Patient Blood Management: Autologous Blood Procurement, Recombinant Factor Vila Therapy, and Blood utilizationLAWRENCE T. COODNOUCH • TERRI Ebook Millers textbook (8/E): Part 4egy. The criteria for autologous donors are different from those for allogeneic donors. Transfusion service policies, implemented under the auspices of hospital transfusion committees, differ regarding collection and use of autologous blood with positive viral markers. It is common practice to exclu Ebook Millers textbook (8/E): Part 4de autologous blood reactive for hepatitis 8 surface antigen and hepatitis c and human immunodeficiency viruses because of patients' safety concerns rEbook Millers textbook (8/E): Part 4
elated to wrong blood unit transfused to wrong patient (mistransfusion). Contraindications to autologous blood donation include evidence of infection Chapter 63Patient Blood Management: Autologous Blood Procurement, Recombinant Factor Vila Therapy, and Blood utilizationLAWRENCE T. COODNOUCH • TERRI Ebook Millers textbook (8/E): Part 4associated with the collection of allogeneic blood.•ANH is the removal of whole blood from a patient while restoring the circulating blood volume with an acellular fluid shortly before an anticipated significant surgical blood loss. The chief benefit of ANH is Use reduction of red blood cell losses Ebook Millers textbook (8/E): Part 4when whole blood is shed perioperatively at the lower hematocrit levels associated with ANH.•The term intraoperative blood collection or recovery descEbook Millers textbook (8/E): Part 4
ribes the technique of collecting and reInfusing blood lost by a patient during surgery. The oxygen transport properties of recovered red blood cells Chapter 63Patient Blood Management: Autologous Blood Procurement, Recombinant Factor Vila Therapy, and Blood utilizationLAWRENCE T. COODNOUCH • TERRI Ebook Millers textbook (8/E): Part 4fused allogeneic red blood cells.•Postoperative blood collection denotes the recovery of blood from surgical drains followed by reinfusion, with or without processing. Postoperative autologous blood salvage and reinfusion are practiced widely but not uniformly.•Recombinant factor Vila (rfVIla) has b Ebook Millers textbook (8/E): Part 4een approved for treatment of bleeding in patients with hemophilia and inhibitors to factors VIII or IX. Pharmacologic doses of rfVIla enhance the thrEbook Millers textbook (8/E): Part 4
ombin generation on activated platelets and therefore may also be of benefit In providing Isemostasis in other situations such as those dsaracterized Chapter 63Patient Blood Management: Autologous Blood Procurement, Recombinant Factor Vila Therapy, and Blood utilizationLAWRENCE T. COODNOUCH • TERRI Ebook Millers textbook (8/E): Part 4on practices. However, no one hemoglobin level should be used as a transfusion trigger, and transfusion decisions should be made for individual patients (see also Chapter 61).•Bloodless medicine and surgery use a multidisciplinary team approach that incorporates anemia management, controlled hemosta Ebook Millers textbook (8/E): Part 4sis, autologous blood procurement, and pharmacologic alternatives to blood transfusion.18811882 PART IV: Anesthesia ManagementBiood management has beeEbook Millers textbook (8/E): Part 4
n defined as “the appropriate use of blood and blood components, with a goal of minimizing their use.”' This goal has been motivated historically by <Chapter 63Patient Blood Management: Autologous Blood Procurement, Recombinant Factor Vila Therapy, and Blood utilizationLAWRENCE T. COODNOUCH • TERRI Ebook Millers textbook (8/E): Part 4s of blood include transmissible infectious disease, transfusion reactions, and potential effects of immunomodulation (eg . postoperative infection or tumor progression). Unknown risks include emerging pathogens transmissible by blood (e.g.. new variant Creutzfeldt-Jakob disease and West Nile virus) Ebook Millers textbook (8/E): Part 4.2-3 Several studies have linked allogeneic blood transfusions with unfavorable outcomes, including increased risk of mortality and various morbiditieEbook Millers textbook (8/E): Part 4
s.4 Blood management has been 1 of the 10 key advances in transfusion medicine since the 1960s.sPatient blood management encompasses an evidence-basedChapter 63Patient Blood Management: Autologous Blood Procurement, Recombinant Factor Vila Therapy, and Blood utilizationLAWRENCE T. COODNOUCH • TERRI Ebook Millers textbook (8/E): Part 4) and multiprofessional (physicians, nurses, pump technologists, and pharmacists).® Preventive strategies are emphasized: to identify, evaluate, and manage anemia7 9 (e.g.. pharmacologic therapy10 and reduced iatrogenic blood losses from diagnostic testing) to optimize hemostasis (eg., pharmacologic Ebook Millers textbook (8/E): Part 4 therapy12 and point-of-care testing1'): and to establish decision thresholds (e g., guidelines) for the appropriate administration of blood therapy.1Ebook Millers textbook (8/E): Part 4
1 15In the United States. The Joint Commission developed patient blood management performance measures and submitted these to the National Quality ForChapter 63Patient Blood Management: Autologous Blood Procurement, Recombinant Factor Vila Therapy, and Blood utilizationLAWRENCE T. COODNOUCH • TERRI Ebook Millers textbook (8/E): Part 4 as a result, these measures currently do not carry consequences if not met. Because these performance measures were process based rather than outcomes based, data on proposed outcomes are difficult to retrieve The Joint Commission has placed these performance measures in their Topic Library, where Ebook Millers textbook (8/E): Part 4they are to be used as additional patient safety activities and/or quality improvement projects by provider institutions as accreditation goals.15 TheEbook Millers textbook (8/E): Part 4
principles of these performance indicators are summarized in Box 63-1.AUTOLOGOUS BLOOD PROCUREMENTThe three types of autologous blood transfusion areChapter 63Patient Blood Management: Autologous Blood Procurement, Recombinant Factor Vila Therapy, and Blood utilizationLAWRENCE T. COODNOUCH • TERRI Ebook Millers textbook (8/E): Part 4he advantages, disadvantages, applications, and complications vary with the techniques used.The two primary reasons for employing autologous transfusion are avoidance ofcomplications associated with allogeneic transfusion and conservation of the national blood inventory. Patients with rare blood phe Ebook Millers textbook (8/E): Part 4notypes or alloantibodies can also benefit from autologous transfusion because compatible allogeneic blood may not always be available.’® Potential coEbook Millers textbook (8/E): Part 4
mplications ofBOX 63-1 Patient Blood ManagementTJC Performance Measures1. Preoperatrve Anemia Screening2 Preoperatrve Blood Type and Antibody Screen (Chapter 63Patient Blood Management: Autologous Blood Procurement, Recombinant Factor Vila Therapy, and Blood utilizationLAWRENCE T. COODNOUCH • TERRI Ebook Millers textbook (8/E): Part 4dicationPrinciplesA.Formulate a plan of proactive management for avoiding and controlling blood loss tailored to the clinical management of individual patients, including anticipated procedures.B.Employ a multidisciplinary treatment approach to blood management using a combination of interventions ( Ebook Millers textbook (8/E): Part 4e.g.. pharmacologk, therapy, point-of-care testing).c Promptly investigate and treat anemia.D.Exercising clinical judgment, be prepared to modify routEbook Millers textbook (8/E): Part 4
ine practices (e.g., transfusion triggers) when appropriate.E.Restrict blood drawing for unnecessary laboratory tests.Chapter 63Patient Blood Management: Autologous Blood Procurement, Recombinant Factor Vila Therapy, and Blood utilizationLAWRENCE T. COODNOUCH • TERRI Chapter 63Patient Blood Management: Autologous Blood Procurement, Recombinant Factor Vila Therapy, and Blood utilizationLAWRENCE T. COODNOUCH • TERRIGọi ngay
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