Download Blood Use in Cardiac Surgery by F. Bachmann, Prof. Fedor Bachmann (auth.), Dr. N. Friedel, PDF

By F. Bachmann, Prof. Fedor Bachmann (auth.), Dr. N. Friedel, Prof. Dr. R. Hetzer, Dr. D. Royston (eds.)

Cardiac surgical procedure has built dramatically because the first open-he artwork operations have been played within the mid Fifties. even if the advance of surgical method, extracorporeal stream, and postoperative administration has contributed to a marked aid of morbidity and mortality, the improvement of cardiac surgical procedure to its current nation should not have been attainable with no blood substitution through homologous donor blood. merely twenty years in the past, open-heart operations required an ordinary of eight devices of blood preserves. The over the top want of donor blood in these early days used to be ordinarily because of untimely surgical strategy, insecure regulate of anticoagulation, serious blood trauma by way of extracorporeal circulate, and the inability of retransfusion applied sciences that will have allowed the reuse of shed mediastinal blood. The advent of recent applied sciences, similar to normovolemic hemodilution, in­ traoperative autotransfusion, postoperative go back of shed mediastinal blood, and predonation of autologous blood has drastically lowered donor blood necessities. at this time nearly all of regimen coronary artery surgeries will be played with none blood transfusion. Blood loss, notwithstanding, can be massive in sufferers present process complicated valve surgical procedure or reoperations, as they generally require numerous devices of transfused blood. Blood conservation has now develop into a space of significant curiosity for the cardiac doctor. This elevated crisis is attributable to infectious issues of blood transfusion, specifically hepatitis and, extra lately, AIDS.

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Surgery 83: 619-625 3. Addonizio VP Jr, Smith JB, Strauss JF III, Colman RW, Edmunds LH Jr (1980) Thromboxane synthesis and platelet seeretion during eardiopulmonary bypass with bubble oxygenator. J Thorae Cardiovase Surg 79: 91-96 4. Addonizio VP Jr, Smith JB, Guiöd LR, Strauss JF III, Co Iman RW, Edmunds LH Jr (l979s) The relationship between thromboxane synthesis and blood protein release during simulated extraeorporeal eireulation. Blood 54: 371 5. Addonizio VP Jr, Strauss JF III, Colman RW, Edmunds LH Jr (1979) Effeets ofprostaglandin EI on platelet loss during in vitro eardiopulmonary bypass.

These investigators [11] were able to define two prototypic types of acquired abnormalities of platelet surface glycoproteins. Patients with adult respiratory distress syndrome had an increased concentration of GMP-140 and thrombospondin on the surface of their platelets, demonstrating in vivo platelet secretion, but had no increase in platelet microparticles in their plasma. In contrast, patients after cardiac surgery with cardiopulmonary bypass demonstrated changes consistent with membrane fragmentation without secretion: a decreased platelet surface concentration of GPIb and GPIIb, no increase in platelet surface GMP-140 or thrombospondin, and an increased plasma concentration of platelet membrane microparticles.

The mechanism by which platelets are initially activated is not known; adenine diphosphate (ADP) may be involved since the plasma concentration from lysed red cells is elevated. Some ofthe activated platelets release alpha and dense granular contents [43] and synthesize thromboxane Az; others do not release [100]. The mean number of platelet membrane "fibrinogen receptors" (GPIIb/IlIa complex) receptors decreases [97]. Platelet membrane fragments, presumably from platelets that detach from the surface, appear in plasma [37].

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