Bleeding and Transfusion

Abstract

July 2006

Section 1 Basic Surgical and Perioperative Considerations

4 Bleeding and Transfusion

John T. Owings, M.D., F.A.C.S.
Professor of Surgery, University of California, Davis, School of Medicine, and Attending Physician, Department of Surgery, University of California, Davis, Medical Center

Garth H. Utter, M.D., M.Sc.
Assistant Professor of Surgery, University of California, Davis, School of Medicine

Robert C. Gosselin, M.T.
Senior Specialist, Hematology/Hemostasis, University of California, Davis, Medical Center

A surgeon is often the first person to be called when a patient experiences ongoing bleeding. To treat such a patient appropriately, the surgeon must identify the cause or source of the bleeding. This chapter focuses on conditions leading to derangement of the hemostatic process, which include a broad spectrum of conditions ranging from aspirin-induced platelet dysfunction to von Willebrand disease to disseminated intravascular coagulation (DIC) and even to hemophilia. This chapter contains discussions of diagnosis and assessment, measurement of coagulation parameters, management of anemia, and indications for transfusion. Detailed sections on cellular components (e.g., erythrocytes, leukocytes, platelets) and plasma components (e.g., procoagulants, regulatory factors) are also included. Novel and experimental therapies for bleeding (e.g., recombinant factor VIIa [rVIIa], prothrombin complex concentrate, QuikClot) are reviewed. The mechanism of transfusion-related immunomodulation and its significance are discussed. Tables outline therapy for hemophilia; management of the patient with an increased international normalized ratio (INR); coagulopathy score; blood substitutes; and tests of platelet function. Transfusion in anemic patients, procoagulant pathways, and coagulation parameters are illustrated in figures. This chapter contains an algorithm reviewing the approach to the surgical patient with ongoing bleeding, 4 figures, 5 tables, and 99 references.

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