Objective: The objective of this study was to determine the exposure of premature infants to lead from blood transfusions. Study design: Blood led concentrations were determined for 19 very premature infants at the ti...
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Objective: The objective of this study was to determine the exposure of premature infants to lead from blood transfusions. Study design: Blood led concentrations were determined for 19 very premature infants at the time of admission, at 4 weeks of life, and before and after transfusions and in the donor packed red blood cells of 79 transfusions. Results: The number of transfusions per patient was 4.2 +/- 2.8 (mean +/- SD) with 15.7 +/- 1.9 mL/kg packed red blood cells for a lead dose of 1.56 +/- 1.77 mug/dL. The total dose of lead from these transfusions over the 4-week period was 4.0 +/- 2.8 mug/kg (range, 0.9-10.6 mug/kg). Increases in post-transfusion blood lead concentration were linear with doses higher than 1.5 mug/dL. Packed red blood cells with a blood lead concentration of greater than or equal to5 mug/dL resulted in an elevated post-transfusion blood lead concentration in some infants. Conclusions: The lead exposure to these infants through blood transfusion exceeds the acceptable daily intake values for lead and may result in unacceptably high post-transfusion blood lead concentrations. Use of packed red blood cells with lead concentrations <3.3 g/dL is one cost-effective means to reduce exposure.
Background: The small but finite risk of postsplenectomy sepsis is generally regarded as a firm indication for splenic preservation after iatrogenic injury, especially in the young. But splenectomy may be preferable i...
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Background: The small but finite risk of postsplenectomy sepsis is generally regarded as a firm indication for splenic preservation after iatrogenic injury, especially in the young. But splenectomy may be preferable in patients who sustain splenic injuries during vascular operations because of the potential for continued bleeding associated with anticoagulation. The purpose of this study was to determine the perioperative morbidity of incidental splenectomy among patients undergoing abdominal vascular operations. Study Design: We studied 17 patients who underwent incidental splenectomy at the time of abdominal vascular operations. Complete data collected on each subject included preoperative and postoperative blood counts, operative indications and details, transfusion requirements, length of hospital stay, and outcomes, Using age- and gender-matched case controls undergoing identical vascular operations from the same period, we evaluated the complication rate and outcomes of patients who underwent splenectomy for iatrogenic injuries of the spleen, versus those who did not sustain splenic injuries. Results: The estimated prevalence of iatrogenic splenic injury during the study period was 0.5%. Mean operative time, estimated blood loss, and duration of mechanical ventilation tended to be greater in the splenectomy patients, but the differences did not achieve statistical significance. Splenorrhaphy was attempted in seven patients, but continued bleeding mandated spleen removal in all cases. Splenectomy patients had a higher transfusion requirement (p = 0.03) and a longer mean length of stay (p = 0.03) than controls. Compared with controls, there was a higher prevalence of infectious complications in the splenectomy patients (p = 0.015), but there was no difference in the prevalence of thromboembolic complications between groups. Two of the splenectomy patients died in the postoperative period from multisystem organ failure, and one died of a missed splenic injury. Co
Background. Studies have shown that aprotinin and tranexamic acid can reduce postoperative blood loss after cardiac operation. However, which drug is more efficacious in a higher risk surgical group of patients, has y...
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Background. Studies have shown that aprotinin and tranexamic acid can reduce postoperative blood loss after cardiac operation. However, which drug is more efficacious in a higher risk surgical group of patients, has yet: to be defined in a randomized study. Methods. With informed consent, 80 patients undergoing elective high transfusion risk cardiac procedures (repeat sternotomy, multiple valve, combined procedures, or aortic arch operation) were randomized in a double-blind fashion, to receive either high dose aprotinin or tranexamic acid. Patient and operative characteristics, chest tube drainage and transfusion requirements were recorded. Results. There was no significant difference between We 2 treatment groups with respect to age, cardiopulmonary bypass time, complications (myocardial infarction, stroke, death), chest tube drainage (6, 12, or 24 hours), blood transfusions up to 24 hours postoperatively, total allogeneic blood transfusions for entire hospital stay, or induction/postoperative hemoglobin levels. However, multiple regression analysis revealed a positive relationship between cardiopulmonary bypass time and 24 hour blood loss in We tranexamic acid group (p = 0.001) unlike the aprotinin group where 24 hour blood loss is independent of cardiopulmonary bypass time (p = 0.423). Conclusions. Overall, there was no significant difference in blood loss, or transfusion requirements, when patients received either aprotinin or tranexamic acid for high transfusion risk cardiac operation, Aprotinin when given as an infusion in a high-dose regimen, was able to negate We usual positive effect of cardiopulmonary bypass time on chest tube blood loss. (C) 2000 by The Society of Thoracic Surgeons.
BACKGROUND: Bleeding complications during laparoscopic surgery are rare but probably underreported. The aim of the current study was to elucidate the clinical relevance of bleeding complications and major vascular inj...
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BACKGROUND: Bleeding complications during laparoscopic surgery are rare but probably underreported. The aim of the current study was to elucidate the clinical relevance of bleeding complications and major vascular injuries during standard laparoscopic procedures. PATIENTS AND METHODS: The Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS) prospectively collected the data on 14,243 patients undergoing different standard laparoscopic procedures (1995 to 1997), These data were analyzed with special interest in intraoperative and postoperative bleeding complications and major vascular injuries. RESULTS: In all, 331 patients (2.3%) had intraoperative bleeding complications. Whereas 44 patients suffered from an external bleed of the abdominal wall, the bleeding was internal in the remaining 287, Thirty-three patients with internal bleeding required blood transfusion with a mean blood loss of 1,630 mt. Surgical hemostasis was necessary in 68% of external and 91% of internal bleeds. There were 250 patients (1.8%) with postoperative bleeding complications. External bleeding occurred in 143 patients, and 107 patients developed internal bleeding. External bleeding was mainly treated conservatively (92%), whereas 50% of internal bleeds required further surgical intervention. Major vascular injuries occurred in 12 patients (incidence 0.08%) with open treatment being necessary in all cases. CONCLUSIONS: Bleeding complications are, in fact, common during laparoscopic surgery. Meticulous dissection technique, immediate recognition, and adequate surgical treatment are mandatory for their management. (C) 2000 by Excerpta Medica, Inc.
Objective: To determine the clinical use and associated costs of routine postoperative hematocrit after elective gynecologic surgery. Methods: We reviewed the charts of all women who had elective gynecologic surgery o...
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Objective: To determine the clinical use and associated costs of routine postoperative hematocrit after elective gynecologic surgery. Methods: We reviewed the charts of all women who had elective gynecologic surgery over 12 months at a community hospital. Demographic data, estimated blood loss at surgery, pre- and postoperative hematocrits, postoperative symptoms suggesting anemia, and incidence of transfusion were tabulated. Laboratory charges for hematocrit at the hospital were used to develop an economic assessment. Statistical analysis was done with Student t test, Mann-Whitney U test, and Fisher exact test. Results: Among 1105 women who had elective surgery, a single postoperative hematocrit was done in 761 (69%) and two or more postoperative hematocrits (mean 2.4, range 2-6) were done in 201 (18%). The overall incidence of blood transfusion related to elective gynecologic surgery was 1.9% (21 of 1105). Five of those women needed preoperative transfusions, eight needed intraoperative transfusions, and the remaining eight had postoperative transfusions. All women who needed postoperative transfusion showed some sign or symptom of anemia. None received transfusions based solely on hematocrit. Risk factors for postoperative transfusion included low preoperative hematocrit and increased intraoperative blood loss. Conclusion: Routine postoperative hematocrit in asymptomatic women after uncomplicated elective gynecologic surgery did not improve outcome. (Obstet Gynecol 2000;95: 847-50. (C) 2000 by The American College of Obstetricians and Gynecologists).
The blood transfusion requirements of a consecutive series of 249 unselected patients with femoral neck fracture were studied retrospectively. A total of 339 Units of blood were transfused (a mean of 1.36 Units per pa...
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The blood transfusion requirements of a consecutive series of 249 unselected patients with femoral neck fracture were studied retrospectively. A total of 339 Units of blood were transfused (a mean of 1.36 Units per patient). Blood transfusion occurred in 132 patients (53.0%), with each receiving a mean of 2.57 Units. Patients aged 80 years and above as a group were transfused significantly more blood than those aged less than 80 years: 1.64 vs 0.94 Units, X-2 = 12.09, p < 0.001. Patients with intertrochanteric fractures were transfused significantly more blood than those with intracapsular fractures (1.74 vs 1.00 Units: X-2 = 13.4, p < 0.001). (C) 2000 Elsevier Science Ltd. All rights reserved.
The survival rate after bleeding requiring massive blood transfusions exceeding 50 units has been reported to be low or zero. There seems to be no reports of leukopenia in connection with massive blood transfusion. Th...
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The survival rate after bleeding requiring massive blood transfusions exceeding 50 units has been reported to be low or zero. There seems to be no reports of leukopenia in connection with massive blood transfusion. This retrospective study was carried out to investigate the survival rate and the occurrence of leukopenia and acidosis in patients who were transfused with more than 50 units of plasma poor red cells or whole blood. The survival rate was 16 of 23. Three of the five patients with a blood transfusion of over 100 units survived. Pure component therapy was used on 18 occasions. All patients had a leukopenia, which lasted up to five days. All patients had an acidosis. The range of the lowest pH values in patients who did not survive was from 6.77 to 7.27 and in survivors from 6.87 to 7.28. The survival rate was considerably higher than reported in previous studies. Pure component therapy appeared to be particularly suited to massive transfusion. Leukopenia was a regular phenomenon. Severe acidosis did not predict a poor outcome. (C) 1999 Elsevier Science Ltd. All rights reserved.
Nosocomial infections are one of the most feared complications after open heart surgery. A large retrospective study was conducted to evaluate the nature and scope of the problem. Between 1992 and 1998, 9352 patients ...
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Nosocomial infections are one of the most feared complications after open heart surgery. A large retrospective study was conducted to evaluate the nature and scope of the problem. Between 1992 and 1998, 9352 patients who had undergone open heart surgery were evaluated. Bloodstream infections, pneumonia, and deep sternal wound infections were included. Univariate and logistic regression analyses were conducted to identify the high-risk patients that were likely to become infected. Three hundred forty-six infections in 276 patients were diagnosed. Age, preoperative albumin level, banked blood requirement, duration of operation, diabetes mellitus, previous open heart surgery, moderate or severe pericardial adhesions, obesity, postoperative low cardiac output, and postoperative cerebrovascular accident were found to be significant in univariate and logistic regression analyses for infectious outcome. Univariate analysis also revealed additional significant factors: fresh frozen plasma requirement, duration of cardiopulmonary bypass and cross-clamp, preoperative high levels of blood urea and glucose, presence of occlusive peripheral arterial disease, preoperative history of hypertension, and nasal carriage of Staphylococcus aureus. Methicillin resistant S. aureus was involved in 58.4% of the infections. Risk factors should be individualized for patients and every effort should be carried out to minimize infectious outcome.
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