American journal of clinical pathology
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Am. J. Clin. Pathol. · Jul 1996
Comparative StudyPrecision, accuracy, and managed care implications of a hand-held whole blood analyzer in the prehospital setting.
Hand-held portable clinical analyzers permit the rapid measurement of whole blood electrolytes, glucose, blood urea nitrogen (BUN) and hematocrit. Knowledge of these values in the field might aid radio telemetry emergency department physicians in the field treatment and triage of patients. The purpose of this study was determine if the analyzer could function in the hostile prehospital environment. ⋯ There was excellent correlation between field and hospital emergency department values. Clinical pathologists extend their oversight and consider encouraging emergency physicians to obtain field blood chemistry values in research studies aimed at improving medical treatment and patient triage in the prehospital setting. We speculate that these results might be important to managed care groups because knowledge of blood chemistry values in the field might provide physicians with objective, criteria-based data on which to triage patients to the emergency department, to an ambulatory care setting, or to a community health center with attendant cost savings.
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Am. J. Clin. Pathol. · Jul 1996
Changes in blood coagulation during and following cardiopulmonary bypass: lack of correlation with clinical bleeding.
Although previous studies have documented a wide variety of derangements in laboratory measurements of blood coagulation and platelets during cardiopulmonary bypass, limited data are available concerning the magnitude of these changes and any association with excessive bleeding. To determine whether abnormalities in commonly available laboratory tests for the evaluation of coagulation, fibrinolysis and hemostasis correlate with postoperative blood loss and transfusion requirements as measures of clinical outcome, 47 consecutive patients undergoing coronary artery bypass grafting with hypothermic cardiopulmonary bypass (CPB) were studied prospectively at 12 time points before, during, and following CPB. Routine blood coagulation tests, coagulation factor levels (fibrinogen, V, VII, VIII, and IX) and fibrinolysis (FDP) became abnormal within 15 minutes after patients were placed on CPB, remained abnormal for the duration of CPB, and recovered at varying rates after discontinuation of CPB. ⋯ Twenty-eight percent of patients had mediastinal output > or = 100 mL per hour during the immediate postoperative period, and were considered to be "bleeders." There were no clinically relevant differences in any of the laboratory measurements between patients with normal postoperative blood loss and those defined as bleeders. Thus, the absence of significant correlations between various laboratory measurements of hemostasis and actual postoperative bleeding indicates that these laboratory derangements are transient, are not predictive of clinically important hemostatic abnormalities, and should not be used in isolation to guide the use of blood components in these patients. Furthermore, although bleeders received more blood components, there was surprisingly little effect on the coagulation factor levels measured.