Transfusion
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Cardiac surgery is occasionally complicated by massive blood loss that is refractory to standard hemostatic interventions. Recombinant factor VIIa (rF-VIIa) is being increasingly used as rescue therapy in such cases, but little information is available on its safety and efficacy for this indication. ⋯ These results suggest that rF-VIIa may be an effective rescue therapy for patients with intractable hemorrhage after cardiac surgery. A clinically important risk of stroke or other major thrombotic complications could not be ruled out by our study. Controlled clinical trials with adequate power to detect the impact of rF-VIIa therapy on morbidity and mortality therefore are necessary before one can recommend its routine use in patients undergoing cardiac surgery who have excessive bleeding.
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Total knee arthroplasty (TKA) or total hip arthroplasty (THA) regularly results in postoperative requirement of blood transfusion. Because of the disadvantages of allogeneic blood transfusion (ABT) such as the risk of transfusion-associated infections, incompatibility-related transfusion fatalities, or immunomodulatory effects, a continuing effort to reduce allogeneic blood transfusion is important. For this purpose, the effect of reinfusion of drain blood, via a postoperative wound drainage and reinfusion system, on the need for allogeneic blood transfusion was evaluated. ⋯ We conclude that the Bellovac ABT device reduces allogeneic blood transfusions in TKA and THA.
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Transfusions are intended to augment oxygen-carrying capacity. The ability of fresh and stored red blood cells (RBCs) to maintain microvascular perfusion and oxygen delivery to the tissue has not been directly measured. ⋯ Circulation of stored RBCs in a hemodiluted animal resulted in significantly malperfused and underoxygenated microvasculature that was not detectable at the systemic level.