bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute Normovolemic Hemodilution (ANH). A practical approach.
Authors: Shander Aryeh 
Published: February 2008

SUMMARYAs one of the modalities available for perioperative blood conservation, ANH presents a dilemma to the clinician for various reasons. First, the efficacy of ANH as a technique for blood conservation has been challenged by some investigators. Others suggest that ANH is only effective with ranges of blood collection and severity of anemia that make most anesthesiologists uncomfortable14. In addition, performance of ANH requires experienced clinicians, and additional work and vigilance by the anesthesiology staff. The combination of skepticism, increased work, and training requirements without the benefit of reimbursement make this simple and valuable procedure one of the most underutilized forms of intraoperative blood conservation techniques. The gain in popularity of all blood conservation techniques in the last decade has resulted in the reexamination of the efficacy of ANH and the need to increase utilization of this technique. Although ANH has been a known modality for quite some time5 6, it has never gained full acceptance among anesthesiologists, surgeons, and others involved in blood conservation. Table 1 raises a number of issues
Crystalloids or Colloids for the Treatment of Hypovolemia?
Authors: Baron Jean‐François 
Published: February 2008

SUMMARYBlood volume is a critical factor in maintaining hemodynamic equilibrium and tissue oxygenation. Intravascular volume is regulated very closely by means of several complex mechanisms, for which the onset of action varies widely. In some situations, such as acute bleeding, sepsis or with the use of certain drugs, the body must withstand absolute or relative changes in blood volume that cannot be immediately compensated for by the regulatory mechanisms. In these situations, the main goal of volume therapy is to temporarily increase plasma volume until the body's own mechanisms can correct the hypovolemia.Treatment of hypovolemia has changed significantly in recent years. In the past, fresh frozen plasma (FFP) or its equivalent was long the volume expander most commonly used. Now, indications for FFP are limited to the correction of some hemostatic disorders. A by‐product of this legitimate change in practice was increased use of human albumin. Because of the financial consequences of this strategy, several consensus conferences have issued recommendations on the best indications for the use of various plasma volume expanders.Despite these recommendations, the choice of the appropriate agent in the treatment of hypovolemia has not yet been settled. The debate on crystalloids versus colloids continues, along with a debate on the choice of colloid.
Oxygen Carriers ‐ What is Behind Us? What is Ahead?
Authors: Spiess Bruce D. 
Published: February 2008

SUMMARYIs there a need for blood substitutes? Five years ago, that question would have met with a nearly universal answer of “yes” as the HIV crisis was front‐page news in every major news publication in the developed world. Today, a number of advances in blood banking have given us the safest blood supply that has ever existed. Therefore, some clinicians have taken that claim (the safest blood supply) and have questioned the need for a “blood substitute”. Although the incidence of viral disease transmission by blood products has drastically declined in the last 10 years and HIV and hepatitis C transmission are now almost vanishingly rare, the other risks of blood transfusion remain. Allergic reaction occurs in approximately 1/100 units transfused and although sometimes dismissed as minor in certain cases, an allergic reaction may be life threatening (e.g. immediately after cardiopulmonary bypass). Graft‐versus‐host reaction, sepsis, transfusion‐related acute lung injury, and incompatibility are now coming more into focus as the viral transmission issues fade.
A New Hydroxyethyl Starch: HES 130/0.4 Voluven®
Authors: Baron Jean François 
Published: February 2008

SUMMARYBlood volume is a critical factor in ma in taining hemody namic equilibrium and tissue oxyge nation. In travascular volume is regulated very closely by means of several complex mechanisms, for which the onset of action varies widely. Insome situations, such as acute bleeding, sepsis or with the use of certain drugs, the body must withstand absolute or relative changes in blood volume that cannot be immediately compensated for by the regulatory mechanisms. In these situations, the main goal of volume therapy is to temporarily increase plasma volume until the body's own mechanisms can correct the hypovolemia.Treatment of hypovolemia has changed significantly in recent years. In the past, fresh frozen plasma (FFP) or its equivalent was long the volume expander most commonly used. Now, indications for FFP are limited to the correction of some hemostatic disorders. A by‐product of this legitimate change in practice was increased use of human albumin. Because of the financial consequences of this strategy, several consensus conferences have issued recommendations on the best indications for the use of various plasma volume expanders.Despite these recommendations, the choice of the appropriate agent in the treatment of hypovolemia has not yet been settled. The debate on crystalloid s versus colloids continues, besides a debate on the choice of colloid.
Risks Associated with Under‐Transfusion
Authors: Wahr Joyce A. 
Published: February 2008

SUMMARYCardiovascular disease accounts for a majority of the deaths each year in westernized countries. Anemia, with its obligatory increase in cardiac output, may present a special risk in these patients. A review of the physiology of acute and chronic anemia as well as the physiology of myocardial ischemia is presented. A review of the literature regarding the risks and recommendations for therapy in this group of high‐risk patients is presented.
Transfusion Morbidity and Mortality in the ICU
Authors: Hébert Paul C 
Published: February 2008

SUMMARYTransfusion of red blood cells (RBC) continues to be an important therapy for treatment of anemia in intensive care settings. The critically ill are a heterogeneous population affected by a variety of pathophysiological processes and are, therefore, predisposed to the – adverse outcomes of anemia. As such, the risks imposed on this population when transfusion therapy is prescribed are of great interest. Over the past decade there has been a shift in transfusion practice with guidelines being developed that promote more conservative and safer use of blood. The Transfusion Requirements in Critical Care (TRICC) trial clearly established the safety of a restrictive transfusion strategy, thereby suggesting that physicians could easily minimize exposure to allogeneic RBCs by lowering their transfusion threshold. Further research will add to the generalizability of this study as well as explore the possible mechanism to explain why red cell transfusions did not improve outcomes in the critically ill.
Lessons from Meta‐analysis: The Case of Albumin
Authors: Soni Neil 
Published: February 2008

SUMMARYEvidence has long been the mainstay of medical practice. The introduction of meta‐analysis as a method coupled with stylized review, the systematic review, has produced a supposedly quantifiable and scientific means of collating evidence. While this has been used to good effect in some areas of medical practice where adequate data exist, it has also been applied in situations where there are woefully inadequate data. An example of this is the issue of the use of albumin. It is the author's contention that the methods used and the conclusions subsequently drawn were inappropriate and heavily flawed. This has given reason to review the validity of meta‐analysis in such circumstances and to challenge the method of systematic review.The lessons learned from meta‐analysis do not relate to the subject of albumin, but to the potential for abuse of statistical method.
Efficacy of Preoperative Autologous Blood Donation
Authors: Mercuriali Francesco , Inghilleri Giovanni 
Published: February 2008

SUMMARYPreoperative autologous blood donation (PABD) is the most widely utilized autotransfusion technique. However, improvements in allogeneic blood safety and increased pressure on cost‐containment command a review of its role by analyzing the need, feasibility, efficacy and cost‐effectiveness of the procedure. Residual risks and shortages of donor blood still support the need for PABD. Experiences worldwide show that the technique has a good feasibility profile when hospital resources are appropriately organized and support its safety in the majority of the patients scheduled for elective surgery. Studies in the United States and Europe demonstrate that PABD is effective in reducing exposure to allogeneic blood. However, the cost‐effectiveness of PABD has been claimed to be poor. Thus, strategies should be adopted to reduce the direct costs of PABD, to optimize its efficacy, and to reduce the collection of unnecessary blood units. PABD should be appropriately planned in order to derive the greatest physiologic benefits from blood collections. For example, it is necessary to start PABD at least 20 days before the operation, to collect at least two units of AB (autologous blood), and to monitor the patient's iron status. A personalized approach to define the patient's transfusion requirements can facilitate the decision about enrollment in a PABD program and define the number of units to be collected from a given patient.
The Changing Transfusion Practice of Neonatal and Pediatric Surgery
Authors: Kling Pamela J. 
Published: February 2008

SUMMARYThe use of erythrocyte transfusions to treat anemia in neonatal and pediatric surgery patients has changed dramatically over the last decade. Recombinant human erythropoietin (rHuEPO) has been shown to decrease transfusion exposure in many disease states in both adults and children. rHuEPO has also been used perioperatively in children. This paper discusses perioperative anemia, the current status of rHuEPO therapy, surgical and non‐surgical strategies that minimize blood loss, and transfusion therapy in the pediatric surgical patient.
Management of the Anemia of Prematurity Using Human Recombinant Erythropoietin
Authors: Ohls Robin K. 
Published: February 2008

SUMMARYThe evolution of clinical practice in the care of extremely low birth weight infants continues to affect their number of transfusions. Advancements such as improved ventilation and treatment of preterm lung disease, the development of pediatric laboratory equipment and microsampling techniques, and the use of alternatives to blood products such as human recombinant erythropoietin (rHuEPO) have all improved transfusion practices in neonatology. EPO has been studied extensively as treatment for a variety of anemias in adults and children. Following in vitro studies of the anemia of prematurity that showed the primary etiology to be decreased EPO concentrations, clinical trials evaluated the administration of EPO to preterm infants to treat the anemia of prematurity. Recent studies have focused on the administration of EPO in the first weeks of life to alleviate the anemia caused by excessive phlebotomy losses, and to prevent the anemia of prematurity. It is likely that EPO administration in combination with instituting rigorous transfusion guidelines and decreasing phlebotomy losses will have the greatest impact in decreasing transfusion requirements in all preterm and term neonates, regardless of the etiology of their anemia.
Using Small‐Volume Resuscitation in Sweden: Observations From Initial Experiences
Authors: Svensén Christer H. 
Published: February 2008

SUMMARYOne of the most striking features of infusing hypertonic solutions is the rapid onset of plasma volume expansion. Following a renewed interest raised by Brazilian researchers in 1980, various hyperosmotic solutions ‐ hypertonic saline alone or in combination with dextran or hetastarch ‐ have been developed for prehospital resuscitation of severe hemorrhagic shock. They have also been used in burns, sepsis, nontraumatic hemorrhages, and vascular and cerebral injuries. While clinical trials have not provided definitive data as to their efficacy, the available studies show that they might be beneficial in improving survival in patients with hypotension associated with traumatic injury. Furthermore, there is much clinical evidence that hypertonic solutions alone or in combination with colloids are the fluid of choice for head‐trauma patients. Numerous studies have already established their safety.
Volume Kinetics – Pharmacokinetics for Fluids
Authors: Svensén Christer H. 
Published: February 2008

SUMMARYFluid therapy is a main component in the management of critically ill patients. Unfortunately, a considerable number of patients receive excessive fluid therapy that results in volume overload and organ dysfunction. There is an obvious need for a more refined scientific method to replace the more or less precise “rules‐of‐thumb.” A new approach to fluid therapy‐volume kinetics‐is the first adaptation of pharmacokinetic theory that allows the behavior of fluid volumes administered during intravenous therapy to be analyzed and simulated.
Volume Kinetics and Hypertonic‐Hyperoncotic Solutions*
Authors: Hahn Robert G. 
Published: February 2008

SUMMARYKinetic analysis may be used to compare the potencies of infusion fluids to dilute venous plasma, which can be used as an index of plasma volume expansion. In male volunteers, Ringer's acetate and Ringer's lactate were between 5% and 15% less potent than 0.9% saline, while 7.5% saline was approximately 4 times and 7.5% saline in 6% dextran 70 approximately 6.5 times more potent than normal saline. Slightly different results were obtained depending on whether only the infusion period or both the infusion and postinfusion periods were studied.
The Dilemma Between Cost‐Effectiveness and Quality of Care in Transfusion Medicine: The Fiduciary Responsibility of the Physician to the Patient With Regard to Blood Transfusion and Transfusion Alternatives
Authors: Ziman Alyssa , Goldfinger Dennis 
Published: February 2008

SUMMARYCost‐effectiveness analysis (CEA) figures prominently in medical decision‐making and, therefore, must be easily applicable and correctly used. Unfortunately, CEA has the potential to be misleading and in many analyses, including those of transfusion safety initiatives, inappropriate benchmarks have been utilized. Consequently, many transfusion safety initiatives have been incorrectly deemed not cost‐effective and subsequently underutilized, allowing cost to dictate practice. This trend in transfusion medicine creates a dilemma for transfusion medicine professionals, who are torn between their roles as patient advocates and providers of quality patient care and as cost‐conscious laboratory administrators. Given patient demand always for the safest, most effective transfusion therapy regardless of cost and the current medical climate dictated by CEA, who should choose which transfusion safety initiative should be implemented or which transfusion product or alternative should be available? We believe that transfusion medicine professionals must first and foremost uphold their fiduciary responsibility to patients by delivering the safest, most effective therapy.
Perioperative Disorders of Primary Hemostasis: Determination and Treatment
Authors: Kretschmer Volker , Darakchtiev Anton , Bade Sascha , Weippert‐Kretschmer Monka 
Published: February 2008

SUMMARYPrimary hemostasis, the first phase of hemostasis after vessel injury, is a complex process involving the platelets and resulting in the formation of the platelet plug that forms the basis for further coagulation (secondary hemostasis). Perioperative bleeding complications are often due to disorders of primary hemostasis. With respect to detection and treatment, functional platelet disorders are a greater problem than thrombocytopenia. Therefore, routine screening tests for primary hemostasis appear to be more important than those usually performed on plasmatic coagulation. Among the various diagnosis tools for the evaluation of primary hemostasis, platelet count and the Platelet Function Analyser (PFA‐100) with epinephrine are sensitive and specific for the detection of primary hemostasis disorders, whereas TEG is only appropriate to detect those caused by thrombocytopenia. Screening tests for primary hemostasis should at least be performed before major or complicated operations. The administration of platelet‐inhibiting drugs before and shortly after surgery should be avoided or stopped in time. Most disorders of primary hemostasis caused by impairment of platelet function can be successfully treated with desmopressin alone or in combination with antifibrinolytics. Platelet count and the PFA‐100 with epinephrine are well‐suited to document therapeutic effect and guide the use of these agents that can considerably reduce the need for platelet transfusion and prevent bleeding complications.
Disseminated Intravascular Coagulation
Authors: Levi Marcel 
Published: February 2008

SUMMARYDisseminated intravascular coagulation (DIC) is a syndrome characterized by systemic intravascular activation of coagulation, leading to widespread deposition of fibrin in the circulation. There is compelling evidence from clinical and experimental studies that DIC is involved in the pathogenesis of microvascular dysfunction and contributes to organ failure. In addition, the massive and ongoing activation of coagulation may result in depletion of platelets and coagulation factors, thereby causing bleeding. Recent insight into important pathogenetic mechanisms that may lead to DIC has resulted in novel preventive and therapeutic approaches to patients with sepsis and a derangement of coagulation. Thrombin generation proceeds via the (extrinsic) tissue factor/factor VIIa route and simultaneously occurring depression of inhibitory mechanisms, such as antithrombin III and the protein C system. Also, impaired fibrin degradation, due to high circulating levels of type 1 plasminogen activator inhibitor (PAI‐1), contributes to enhanced intravascular fibrin deposition. Supportive strategies aimed at the inhibition of coagulation activation may theoretically be justified and have been found to be beneficial in experimental and initial clinical studies. These strategies include inhibition of tissue factor‐mediated activation of coagulation or restoration of physiological anticoagulant pathways via the administration of antithrombin concentrate or recombinant human activated protein C.
Management of Anemia: Erythropoietin Therapy or Red Blood Cell Transfusion?
Authors: Goodnough Lawrence Tim 
Published: February 2008

SUMMARYErythropoietin therapy was approved for use as a blood conservation intervention beginning in 1989 for patients with medical anemia and in 1997 for surgical patients. The adoption of this strategy has been rapid in some settings (e.g., renal failure patients), progressive in others (e.g., cancer patients), and slow in others (e.g., surgery patients). At the same time, the risks of blood transfusion have declined substantially whereas the costs of blood transfusion have increased significantly. Issues regarding the risks and costs associated with blood transfusion have led to a reevaluation of clinical transfusion practices. The evolution of new techniques such as acute normovolemic hemodilution (ANH) and the novel erythropoiesis‐stimulating protein (NESP) bring new options to allogeneic blood transfusion. Erythropoietin therapy, with or without autologous blood procurement, is undergoing new scrutiny as an alternative to blood transfusion. This is not only because of traditional concerns regarding blood risks but because of new blood inventory and cost considerations.
The Emerging Dutch Hemovigilance System: Voluntary and State‐of‐the‐Art
Authors: Poel Cees L. van der , Schipperus Martin R. 
Published: February 2008

SUMMARyIn 1996 the Dutch Inspectorate of Health enquired whether a national surveillance system for hemovigilance could be developed for the Netherlands. This request was inspired by the Untied Kingdom's initiative to install a reporting system for serious hazards of transfusion (SHOT).An independent foundation named TRIP (Transfusion Reactions in Patients) was established, owned by the professional medical societies engaged in blood transfusion. TRIP was formally launched at the 5th European Hemovigilance Seminar in Amsterdam on February 6–7, 2003.The TRIP office has the aim to anonymously collate, register, analyze and report on the safety of blood transfusion. In addition, TRIP aims to enhance the safety of blood transfusion by educational programs on blood transfusion safety.The TRIP program closely resembles the British SHOT system, in being a voluntary system supporting professionals and in its focus on serious adverse events. It is recognized that underreporting may exist, but it is felt that in The Netherlands a voluntary system would be more productive than a compulsory system.TRIP holds the view that the correct and optimal use of blood is as important for blood transfusion safety as is the prevention of adverse events. In the future, it is envisaged that TRIP will participate in the education of nurses, doctors and technicians in blood transfusion safety.
Assessment of the Risk of Transfusion‐Transmitted Viral Infections
Authors: Kleinman Steven , Vamvakas Eleftherios c. 
Published: February 2008

SUMMARyThe risk of transfusion‐transmitted viral infections is presently exceedingly low, and mathematical modeling is necessary to estimate the magnitude of the residual risk. Direct calculation of the risk from prospective studies of transfusion recipients is either not possible or prohibitively expensive. The accumulated experience with the incidence/window‐period model indicates that this approach can predict (1) the approximate residual risk of transfusion‐transmitted infections that are characterized by an infectious window period before appearance of infectious disease markers in peripheral blood; and (2) the approximate risk reduction that can be expected with implementation of new tests.
Intravenous Fluids and Renal Failure
Authors: O'Malley Catherine M.N. 
Published: February 2008

SUMMARYNumerous intravenous fluid preparations are available for administration to patients in the clinical setting. These fluids have traditionally been described as either crystalloid or colloid but they may be further classified according to the nature of the solution itself, i.e. 0.9% NaCl (normal saline) or balanced salt‐based fluids (e.g., lactated Ringer's solution).Until recently, little attention has been paid to the potential systemic effects of intravenous fluids that occur independently of their efficacy as agents for intravascular volume replacement. This article explores the available data regarding the impact of intravenous fluids on the kidney to determine whether there is any evidence linking intravenous fluid administration and the pathogenesis of renal dysfunction or renal failure. Particular reference is made to 0.9% NaCl and the hydroxyethylstarch solutions but other fluids such as gelatin and dextran are also considered. In addition, the metabolic effects of intravenous fluids are discussed as these may influence the choice of fluid type in patients with impaired renal function and renal failure.
Hyperchloremic Acidosis: Pathophysiology and Clinical Impact
Authors: Burdett Edward , Roche Antony M. , Mythen Michael G. 
Published: February 2008

SUMMARYHyperchloremic acidosis is a predictable consequence of normal saline‐based fluid administration. The theoretical basis for this is easily understood using Stewart's model of acid‐base homeostasis. Data are emerging which describe the consequences of hyperchloremic acidosis in the surgical population.