Should We Use Preoperative Epoetin-α in the Mildly Anemic Patient Undergoing Simultaneous Total Knee Arthroplasty?

Simultaneous knee arthroplasty is associated with significant blood loss. To prevent transfusion, three preoperative doses of epoetin-α were offered to mildly anemic simultaneous knee arthroplasty patients. A retrospective review, using ICD-9 codes, identified twenty patients from 2007-2009. Epoetin-α increased hemoglobin levels preoperatively (12.6 to 13.9,

Progress Notes

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Intercultural Competences in Health Care - Jehovah's Witnesses

After Poland's accession to the European Union, borders were opened and migrations from many culturally different countries intensified, which led to an increase in immigrants and refugees assimilating in Poland. Numerous ethnic, religious, linguistic and cultural groups existed and exist in Poland. All of these groups benefit from health services. The above situation requires medical personnel to perceive the patient through the prism of his biological, psychological, social and health problems, as well as in terms of spiritual needs of religions, as well as beliefs and socio-cultural origin. Therefore, knowledge about the cultural differences of healthcare service recipients and shaping intercultural sensitivity among healthcare workers is essential. This work examines multiculturalism in health care based on the example of the confession of Jehovah's Witnesses. Its aim was to get to know the health service opinions regarding cultural competences in specific work with patients

The feasibility and physiological aspects of anesthesia and surgery without homologous blood transfusion

The modern practice of medicine has an ever-increasing dependency on the blood bank industry. Indeed, on many occasions there is an unwarranted and inappropriate use of hemotherapy. The first recorded blood transfusion was given to Pope Innocent VIII in 1492 (Narengo-Rowe, 1982). three blood donors This treatment was unsuccessful, and the patient and all died as a result of the experiment. Since then physicians have been mesmerized by the "0mnipotent" powers of extraneous blood in reversing disease processes, regardless of the inherent complications or the logical indications for such blood transfusions. It has been estimated that 12 million units of blood are transfused yearly into patients in the United States. This blood comes primarily from volunteer sources, but paid donors must necessarily be used, in order to make up for shortages created by the ever increasing demand. In addition, the cost of whole blood has risen steadily to $100.00 per unit in some hospitals and frozen blood is double this price. On average 2.5 units of blood are used for each transfusion and retrospective data analyses of the need for individual blood transfusions have unifonnly demonstrated that at least half of all blood transfusions were unnecessary. The risks of using homologous blood include isosensitization- disseminated intravascular coagulopathy, febrile reactions, bacterial contamimation, thrombophlebitis, hepatit

Recommendations for the implementation of a Patient Blood Management programme. Application to elective major orthopaedic surgery in adults

Methodology for producing the recommendations for the implementation of a Patient Bloo

The Extent to Which Cell Salvage Can Support Patient Blood Management

Cell salvage involves the recycling of a patient’s own blood shed during or after an operation. The procedure is mainly used in the specialties of orthopaedics, cardiac and obstetrics where high volumes of blood loss are expected. The cell salvage process can therefore obviate the need for a patient to require a blood transfusion using donated (allogeneic) blood.This thesis examines the cost effectiveness of cell salvage in primary total hip replacement surgery. It compares data for three hospital sites in England; one an extensive user of cell salvage and two sites that do not utilise cell salvage. The thesis concludes that recent procedural changes and the adoption of published blood management guidance can reduce the requirement for a patient to require an allogeneic blood transfusion. These changes render both intra-operative and post-operative cell salvage unnecessary to support most primary total hip replacement operations.The thesis recommends further comparative studies in surgery with higher potential blood loss to assess the impact of intra-operative cell salvage in a less predictable operating environment

Τεχνικές περιορισμού των μεταγγίσεων στην αρθροπλαστική ισχίου

Σκοπός της παρούσας διπλωματικής εργασίας είναι η παρουσίαση των τεχνικών που χρησιμοποιούνται πριν, κατά τη διάρκεια και μετά το χειρουργείο αρθροπλαστικής ισχίου για τον περιορισμό των μεταγγίσεων. Στο εισαγωγικό μέρος γίνεται αναφορά στον ορισμό της αρθροπλαστικής ισχίου αλλά και στις εξελίξεις στην Ορθοπαιδική που επηρεάζουν τις ανάγκες για μετάγγιση αίματος. Παράλληλα ακολουθεί εκτενής αναφορά στη χορήγηση σιδήρου, ερυθροποιητίνης και τρανεξαμικού οξέος που συνέβαλαν σημαντικά στην μείωση της απώλειας αίματος διεγχειρητικά αλλά και μετεγχειρητικά. Συμπερασματικά, θα διαπιστώσουμε ότι η εφαρμογή νέων φαρμακευτικών πρωτοκόλλων όπως το τρανεξαμικό οξύ, η χορήγηση τοπικής διήθησης με συνδυασμό αναισθητικού και αγγειοσυσπαστικού φαρμάκου, η μείωση του οδού μετάγγισης αλλά και η εφαρμογή μικρότερων και ελάχιστα επεμβατικών προσπελάσεων συνέβαλαν στη βελτιστοποίηση των τεχνικών περιορισμού των μεταγγίσεων στις επεμβάσεις αρθροπλαστικών ισχίουThe aim of this diploma thesis is to present the techniques used before, during and after the hip arthroplasty surgery to limit transfusions. The introductory part refers to the definition of hip arthroplasty, but also to developments in Orthopedics that affect blood transfusion needs. At the same time, there is extensive reporting on the administration of iron, erythropoietin and tranexamic acid, which contributed significantly to the reduction of blood loss both intraoperatively and postoperatively. In conclusion, we will find that the application of new pharmaceutical protocols such as tranexamic acid, the local anesthetic and vasoconstrictive drug combination infusion, the reduction of the transfusion pathway and the application of smaller and minimally invasive accesses have contributed to the optimization of transfusion-limiting techniques in interventions hip arthroplasty

Studies on the clinical epidemiology and pathophysiology of anaemia and blood transfusion in critically ill and elective orthopaedic patients

Anaemia commonly complicates surgery and critical illness. This thesis comprised four studies ofthis important clinical problem. Thefirst study was a retrospective study based in a major teaching hospital Intensive Care Unit (ICU). Three existing datasets were merged to provide a study dataset that described the demographics and severity of illness for a cohort of critically ill patients (n = 489). The epidemiology of anaemia during ICU admission to death or discharge home from hospital was described. 81.5% of patients were discharged anaemic to the community after surviving critical illness. 35.5% had a haemoglobin concentration <100g/L. 82% of patients had normocytic normochromic blood indices at hospital discharge. The second study was a prospective observational study that further investigated blood transfusion practice in a cohort of patients (n = 185) after ICU discharge. 72.2 % of these patients were discharged home anaemic; 83% had normocytic normochromic blood indices at hospital discharge. These data confirmed the retrospective analysis. Hospital physicians used restrictive transfusion practice after ICU discharge; the median pre-transfusion Hb was 74 g/L (interquartile range: 68-76 g/L). The third study measured red blood cell 2,3- diphosphoglycerate (2,3-DPG) levels and P50, which both reflect the ability of red cells to deliver oxygen to tissues, in a prospective cohort of 111 patients admitted to the ICU. Factors that were associated with 2,3-DPG and P50 were investigated. The data showed that critically ill patients have lower levels of 2,3-DPG compared with normal healthy controls. Red cell 2,3-DPG during critical illness had a strong association with patients' acid base status. Acidemia was strongly associated with low DPG concentrations, which was counterintuitive. 2,3-DPG concentration had the strongest association with P50 raising the possibility that oxygen unloading could be impaired in critically ill patients. The fourth study merged several large existing databases to document the incidence, patterns, and likely aetiology of anaemia and the incidence of red cell transfusion in patients presenting for elective major orthopaedic surgery. The dataset comprised approximately 3500 patients presenting over one year to a single orthopaedic hospital. The relation between pre-operative haemoglobin status, other factors, and peri-operative transfusion was investigated. 17 % of patients with known pre¬ admission Hb levels were anaemic. Most ofthese patients (64%) had normocytic normochromic anaemia. 303 patients received a total of 838 red cell units. Low per-admission Hb levels were common among those who were transfused during hospital admission