Eliminating homologous blood transfusions during abdominal aortic aneurysm repair

Article Abstract:

The use of large quantities of homologous blood (blood donated from other people) has come into question recently, as public awareness of the possibility of receiving infected blood has grown. Measures to reduce reliance on banked blood include intraoperative salvage (recovery) of a patient's blood during surgery and donation of blood prior to elective surgery by the patient himself for his own use (autologous blood). To avoid the use of homologous blood, estimates were made of the amount of autologous blood needed for patients undergoing elective abdominal aortic aneurysm (AAA) repair (surgical repair of a dilatation in the wall of the abdominal aorta, the large vessel carrying blood to the lower part of the body). The transfusion histories of 100 AAA repair patients were reviewed. Salvage during surgery was accomplished by removal of blood from the operative field by aspiration; washing the blood and centrifuging it (rapid spinning to allow the cells to separate out); adding the washed cells to a collection pack; and reinfusing the solution. The autologous donor program was started one month before surgery whenever possible. The results showed that a total of 445 units of blood were transfused, with larger aneurysms requiring more blood. One hundred sixty-six units were homologous, while 255 units were from salvage, and only 24 were donated in advance (63 percent autologous). The number of units donated prior to surgery that are necessary to obviate the homologous contribution, assuming that intraoperative salvage continues, would be two units for smaller aneurysms and three for larger aneurysms. This estimate assumes an operating room staff skilled in salvage procedures. It is hoped that use of a patient's own blood will become a more common feature of surgical protocols. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Blood transfusion, Autologous, Autologous blood transfusion, Abdominal aneurysm, Abdominal aortic aneurysm

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Delayed thromboembolectomy for subacute limb ischemia

Article Abstract:

The obstruction of a blood vessel in the leg can result in disastrous ischemia (inadequate blood supply) and possibly loss of the leg. Acute embolism in the leg, or vascular obstruction generally caused by a blood clot in the circulation, is treated by urgent thromboembolectomy (surgical removal of the clot). Today, patients with thromboembolic disease are older and more prone to have atherosclerotic disease than were patients in the past. In this older population it may be difficult to differentiate between embolus and thrombosis (an abnormal condition in which clotting elements and debris accumulate and attach to a point on the interior wall of a vessel). Sometimes clots can cause subacute leg ischemia that is not recognized as an embolism. A report is presented of five patients (seven limbs) who were identified by history, physical examination, noninvasive study and/or angiography to have leg ischemia caused by thromboembolism which had occurred 3 to 10 weeks earlier. All patients underwent thromboembolectomy with salvage of the leg. Hemodynamics (blood flow) returned to normal in six of the seven legs; in one leg, there was minimal occlusive disease, which had been noted prior to surgery. In each of the seven legs there was evidence of new emboli at the time of surgery. These results indicate that chronic thromboembolism is an under-recognized occurrence. Even when diagnosis is delayed, the leg may be saved. It is noted that the patients in this study had advanced heart disease and would not have been offered the option of vascular bypass surgery unless it was an emergency. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Embolism, Leg, Blood vessels, Thromboembolism, Ischemia, Embolectomy

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