[HSF] Reclacitrant sternal bleeding

Sun Dec 10 05:11:09 EST 2006

you mean spot test the donor ? .... I use that in elective cases when I have
time to test the relatives against all serological test required. I hardly
use any donors ... insist on healthy RELATIVES ..... it works .... 

NFA
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of prasannasimha
> Sent: Saturday, December 09, 2006 8:08 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Reclacitrant sternal bleeding
> 
> We used to get it at one time - (pretested donors and direct bleeding)
> but that is no more allowed and we at the most can bleed the patient and
> "spot test" the blood bag but that still takes time.
> Prasanna
> 
> Nasser F. Abou'Seada wrote:
> > 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
> >>>
> >
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