[HSF] Reclacitrant sternal bleeding

Sun Dec 10 10:01:04 EST 2006

well .... yes ... they insist on that .... yet my argument is to spare the
cost of the bag should the donor prove to be unsuitable to donate blood for
one reason or another ... 
Also .... I do ask the relatives of the patient to pay for the costs
themselves .... costs of screening against HBV and HIV ..... they choose the
best donor to start with ...

However .... the routine practice is to use blood products .... yet I tend
to always make sure to have 2-3 individuals ready if needed .... 

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of psimha
> Sent: Sunday, December 10, 2006 9:46 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Reclacitrant sternal bleeding
> 
> Our blood banking rules now prevent pretesting of the donor directly.
> Only the  bags can be tested.
> Prasanna
> Nasser F. Abou'Seada wrote:
> > 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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