Transfusion
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Editorial Randomized Controlled Trial Clinical Trial
Albumin--does the bell toll for thee?
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Clinical Trial
Variability of prothrombin time and activated partial thromboplastin time in the diagnosis of increased surgical bleeding.
Prothrombin time (PT) and activated partial thromboplastin time (APTT) are used to diagnose causes of increased surgical bleeding and to guide treatment of acquired coagulation factor deficiency. This study compared the sensitivity of various commercial PT and APTT tests in patients with dilutional coagulopathy. ⋯ In surgical patients with dilutional coagulopathy, diagnostic and treatment decisions could depend on which PT and APTT test was used to determine the etiology of increased bleeding. This study indicates that the relationship between increased bleeding and an increased PT and APTT may be more difficult to define than is suggested by current practice guidelines. Each laboratory must establish guidelines based on reagent and instrument sensitivity to coagulation factor dilution.
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The utility of a pretransfusion bedside blood compatibility protocol to decrease immunohemolytic accidents has been questioned for years. ⋯ Bedside pretransfusion compatibility determination should not be considered a reliable supplemental safety procedure in the hands of inexperienced and insufficiently trained operators.
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The hemostatic effect of platelets has been well established, but the possible role of red cells in hemostasis has not yet been well studied. An evaluation of the hemostatic effect of packed red cell transfusion in patients with chronic anemia was the purpose of this study. ⋯ Red cell transfusion might decrease the APTT and BT in some anemic patients, though the actual cause of the decrease was not determined in the present study.
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Randomized Controlled Trial Clinical Trial
Perioperative myocardial ischemic episodes are related to hematocrit level in patients undergoing radical prostatectomy.
The anemia associated with perioperative blood conservation has raised concerns regarding the safety of these strategies in patients with ischemic cardiovascular disease. Therefore the relationship between hematocrit level and myocardial ischemic episodes in a group of elderly patients undergoing elective noncardiac surgery was studied. ⋯ A hematocrit level < 28 percent is independently associated with risk for myocardial ischemia during and after noncardiac surgery. Avoidance of cardiac complications may require higher transfusion thresholds, closer attention to tachycardia, or better monitoring for ischemia.