[HSF] Reclacitrant sternal bleeding

[Nasser F. Abou'Seada]

Dear Jay 
Nice to hear from you again ..
Nice study ... apparently well organized. the good point is that it provides
documented proof as for the superiority of Fresh blood from a PLATELET'S
perspective. 
Evidence is there that there is a real difference for using ultra-fresh
blood, apart from the boiling blood of Hal, with respect to AVAILABILITY of
Factor VIII, Factor V, Factor IV "Supplemented" .... also the RATE of
administration effecting simultaneous building up of a threshold level of
COAGULATION FACTORS, necessary to start a cascade with successful clotting,
rather than consumption .... leading to coagulopathy ... 
Other effects of Fresh Blood are many, however the effects on Coagulation
are prominent. 

NFA 

> From: Jacob Lavee, MD
> Bob and Nasser,
> Old tricks never die, they unfortunately just fade away. Please read my
abstract from
> 1989 regarding the clear clinical and electron-microscopy prooved benefit
in using one
> unit of fresh whole blood after cardiac surgery:
> 
>  J Thorac Cardiovasc Surg. 1989 Feb;97(2):204-12.
> The effect of transfusion of fresh whole blood versus platelet
concentrates after
> cardiac operations. A scanning electron microscope study of platelet
aggregation on
> extracellular matrix.
> Lavee J, Martinowitz U, Mohr R, Goor DA, Golan M, Langsam J, Malik Z,
Savion N.
> Department of Cardiac Surgery, Maurice and Gabriela Goldschleger Eye
Research
> Institute, Sheba Medical Center, Tel Hashomer, Israel.
> 
To evaluate the effect of 
fresh whole blood transfusion versus platelet concentrates transfusion 
on platelet aggregation after cardiac operations, 
24 patients were randomized to receive either 
one unit of fresh whole blood (12 patients) 
or 10 platelet units (12 patients) after cardiopulmonary bypass. 
Platelet aggregation on extracellular matrix, 
platelet count, 
and mean platelet volume were studied preoperatively, at termination of
cardiopulmonary bypass, after protamine administration, and after the
transfusion of fresh whole blood or after transfusion of each two platelet
units. 
Extracellular matrix produced by cultured bovine corneal cells closely
resembles the vascular subendothelial basal lamina, and is an ideal in vitro
model in the study of platelet interaction with the subendothelium. 

Platelet aggregation on extracellular matrix, studied by a scanning electron
microscope, was graded from 1 to 4, wherein 
grade 1 represents nonactivated platelets and 
grade 4 a mature platelet aggregate. 
With this grading system, the two groups were 
similar in preoperative values (3.3 +/- 0.9 versus 3.7 +/- 0.4) and 
values after cardiopulmonary bypass (1.5 +/- 1.0 in both groups). 
One unit of fresh whole blood restored platelet aggregation on extracellular
matrix to preoperative status (3.0 +/- 1.0), 
whereas eight platelet units were needed for the same result (3.2 +/- 0.8). 
One unit of fresh whole blood increased platelet count in a manner similar
to that achieved by six platelet units and increased mean platelet volume to
a level higher than that achieved by 10 platelet units. 
These results suggest that the effect of one unit of fresh whole blood on
platelet aggregation after cardiopulmonary bypass is at least equal, if not
superior, to the effect of 8 to 10 platelet units.
 Jay  Lavee

> From: <Rwmfglycar at aol.com>
> > Dear Nasser,
> > I saw the hot blood trick done by my father in 1944. I went with him  to
do
> > a prostatectomy in a country town, He did a Freyer prostatectomy and the
> > prostate bed bled. Multiple stitches, packs, local adrenaline did not
stop the
> > bleeding. His mask was not properly over his nose and sweat from his
forehead
> > trickled down his nose and dropped into the bladder. He called for a
blood
> > donor. Within half an hour a gentleman in his street clothes was wheeled
into
> > the operating theatre. A quick cross match was done on a glass slide.
The
> > donor was brought close to the operating table. There were steel needles
in
> > patient and donor  arms, connected by tubing that met in  a threeway
stopcock.
> > With a big glass syringe blood was pulled from the donor  and then
pushed into
> > the patient. I can't remember how many syringe fulls were  delivered but
by the
> > time the transfer was completed the bleeding had stopped  and the
operation
> > could be completed. I was the fly on the wall watching this.  Later we
drove
> > home in his Hudson car. He told me later that the patient had  done
well,
> > Bob