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Low Hct vs. Transfusing?

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britney121 View Drop Down
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  Quote britney121 Quote  Post ReplyReply bullet Topic: Low Hct vs. Transfusing?
    Posted: Feb 24 2010 at 2:27pm
I recently read the article that perfusion.com had about hematocrit on CPB; saying that there is an increased morbidity with having your lowest hematocrit on pump being less than 28%. I'm not sure what everyone else does but I don't like to transfuse my patients until they get into the lower 20s. I was trained into the school of thought that blood products are bad and to try my best to only use autologous blood to get the patients hct back up after bypass. I was wondering what the feeling is about hct on bypass. Is it better to transfuse and keep the hct up, or don't give blood products and have a lower hct on pump?
 
Britney Landree CCP
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DWF4236 View Drop Down
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  Quote DWF4236 Quote  Post ReplyReply bullet Posted: Feb 27 2010 at 10:07am
Britney,
In your post you stated that "I'm not sure what everyone else does but I don't like to transfuse my patients until they get into the lower 20s." Does that mean that the decision to transfuse during CPB is yours or just that if you had a choice you would choose not to transfuse until the Hct falls into the lower 20's?   If it is your decision, do you take pre CPB variables such as the age of the patient, the patient's ejection fraction, or h/o cerebral vascular disease into consideration? During CPB do you take venous oxygen saturation, difficulty maintaining BP without pharmacological support, on-going acidosis, etc. into account. The Hct needed, to adequately meet the patient's metabolic demands on CPB, is certainly lower than that which is needed after coming off bypass (no more hypothermia, return of cardiopulmonary function/oxygen consumption, no blood flow "knob" to set cardiac output, etc.).  If more packed cells are needed post CPB, and not during CPB, then should we let the anesthesiologist make the call at that time?
In general, I have read many postings from CCP's in which they discuss "their practice". When it comes to the decision to add blood, medications, and anesthetics (inhaled or IV) to the CPB circuit, are there CCP's who make these determinations independently? If so, what is the source of these privileges? i.e. hospital specific, national certification, state licensure, AmSECT's "Scope of Practice".  Those of you who do make these practice decisions, are the surgeons and/or anesthesiologists signing your perfusion record or some other documentation?
Regards,
David Fried
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skindiver View Drop Down
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  Quote skindiver Quote  Post ReplyReply bullet Posted: Feb 15 2013 at 5:35am
our cpb team choice to transfuse until the htc fall into the lower 25s..
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