Index: A | B | C | D | E | F | G | H | l | K | L | M | N | O | P | R | S | T | V | Z |

A [TOP]

AABB: The American Association of Blood Banks is a knowledge-based organization that is focused on improving health through advancing the science and practice of transfusion medicine and cellular therapies to optimize patient and donor care and safety.

ABCP: The American Board of Cardiovascular Perfusion is the certifying body for cardiovascular perfusionists in the United States.

Acute Normovolemic Hemodilution (ANH): Acute normovolemic hemodilution (ANH) is a blood conservation modality used in the operating room by anesthesiologists. Whole blood is drained by gravity into blood collection bags containing anticoagulant. As blood is collected, asanguineous fluid, either colloid and/or crystalloid, is infused to maintain hemodynamic stability and “normovolemia.” This process tends to dilute the patients’ blood, hence the term “hemodilution.” On completion of the surgical procedure, the patient’s whole blood is reinfused. Other terms used are acute isovolemic hemodilution and intraoperative autologous donation (IAD). ANH creates a personalized blood bank for patients, since fresh whole blood contains red blood cells, coagulation factors and platelets.

Adhesives: Human-derived or synthetic products that can be used in surgery to support the body’s ability to clot and reduce bleeding (see also Thrombin‘).

Advanced Directive: Is a legal document giving instructions as to the type and degree of medical care to be administered in the event that the person signing the document becomes mentally incompetent during the course of a terminal illness, or becomes permanently comatose (persistent vegetative state). State legislatures have enacted so-called Death with Dignity laws to protect the rights of patients to refuse medical care, including life-prolonging and palliative care in terminal illness, as well as to clarify the role of physicians and indemnify them against the accusation of euthanasia or physician-assisted suicide when they withhold such care in compliance with patients’ wishes. These laws spell out strict procedural requirements, including the need for the signing of an advance directive to be duly witnessed, and make it easier to revoke an advance directive than to establish one. When an advance directive provides instructions for the types of care the patient does or does not want to receive, it is known as a living will. When it names another person to make such decisions, it is known as a durable power-of-attorney for health care decisions. An advance directive can contain both types of instruction. An agent making end-of-life decisions on behalf of a patient is required to follow the patient’s instructions, interpreting them when necessary in the light of the patient’s personal philosophy, religious beliefs, and ethical values, and with due consideration for the likelihood that the patient will regain competency or will recover.

Advanced Transfusion Practices: Transfusion alternatives available to treat patients without the use of donor blood.

Albumin: A type of simple protein, varieties of which are widely distributed throughout the tissues and fluids.

Allogeneic: Describes the genetic differences between two individuals.

Allogeneic Blood: Blood that is donated from a person other than oneself. (Also known as banked or homologous blood) The term is typically used for biological material taken from different individuals of the same species. Two or more individuals are said to be allogeneic to one another when the genes at one or more loci are not identical.

Alloimmunized: The creation of immunity due to the development of antibodies.

Alveolocapillary Membrane: The pulmonary diffusion barrier where oxygen is exchanged.

Anemia: Any condition in which the number of red blood cells per mm3, the amount of hemoglobin in 100 ml of blood, and/or the volume of packed red blood cells per 100 ml of blood are less than normal; clinically, generally pertaining to the concentration of oxygen-transporting material in a designated volume of blood. Anemia is frequently manifested by pallor of the skin and mucous membranes, shortness of breath, palpitations of the heart, soft systolic murmurs, lethargy, and fatigability.

Antianemic: Pertaining to factors or substances that prevent or correct anemic conditions.

Antifibrinolytic: Denoting a substance that decreases the breakdown of fibrin; e.g., aminocaproic acid.

Antihypertensive agents: Indicating a drug or mode of treatment that reduces the blood pressure of individuals with high blood pressure.

Apheresis: A technique in which blood products are separated from a donor and the desired elements collected and the rest returned to the donor.

Autologous Blood Transfusion: Blood that the donor has donated previously and then receives back, usually during surgery.

Autotransfusion: A process when a person receives their own blood for a transfusion, instead of banked donor blood. Blood can be pre-donated before a surgery, or can be collected during and after the surgery using a device commonly known as the Cell Saver. The Cell Saver is utilized in surgeries where there is expected

B [TOP]

Bicarbonate: A central buffering agent in blood.

Blood Coagulation: The process of forming a blood clot where the soft, coherent, jelly-like red mass resulting from the conversion of fibrinogen to fibrin, thereby entrapping the red blood cells (and other formed elements) within the coagulated plasma.

Blood Component: A therapeutic component of blood intended for transfusion (e.g., red cells, granulocytes, platelets, plasma, cryoprecipitate, cyrosupernatant plasma) that can be prepared using the equipment and techniques available in a blood centre.

Blood Component Sequestration or Aphaeresis: Like acute Normovolemic hemodilution, blood is removed from a patient at the start of surgery. The blood is fractionated into its primary components of plasma, platelets and red blood cells. Each component is given back to the patient during surgery as needed with the ideal being that the platelets and plasma are left for the end of the procedure. Because of the time that is required to pull the blood out and to fractionate it, this procedure is generally reserved for major blood loss procedures where significant blood loss is almost guaranteed (for example cardiac surgery).

Blood Fractions: Are components that make up whole blood. They consist of major and minor fractions. Major fractions include RBC, WBC, plasma and platelets. Minor blood fractions include albumin, cryo, immune globulin and clotting factors.

Blood Product: Is any therapeutic product derived from human blood or plasma, and produced by a manufacturing process that pools multiple units (usually more than 12) e.g. human serum albumin, immunoglobulin preparations, and coagulation products (factors VIII and IX, fibrinogen, anti-thrombin III, etc.).

Blood Transfusion: The process of administering blood or blood components from one person into the circulatory system of another. Blood transfusions can be life-saving in some situations, such as massive blood loss due to trauma, or can be used to replace blood lost during surgery.

Blood Viscosity: Is the thickness of blood. Is the resistance of blood to flow because of a shearing force.

Blood Volume: Is the total amount of blood in a person’s body.

“Bloodless” Medicine and Surgery: Medical or surgical treatment without the use of banked (stored) allogeneic blood or primary blood components.

Bone Marrow: The soft, pulpy tissue filling the medullary cavities of bones in which the stroma primarily contain the developmental stages of erythrocytes, leukocytes, and megakaryocytes.

C [TOP)

Capillaries: The tiniest blood vessels in the body.

Carbaminohemoglobin: Carbon dioxide bound to hemoglobin; approximately 20% of the total content of carbon dioxide in blood is combined with hemoglobin in this manner.

Cerebral Oximetry: a noninvasive technology that continuously monitors cerebral tissue oxygen saturation, which is a sensitive index of global cerebral oximetry.

Chelates: A complex formed through chelation that is a complex formation involving a metal ion and two or more polar groupings of a single molecule; thus, in heme, the Fe2+ ion is chelated by the porphyrin ring. Chelation can be used to remove an ion from participation in biological reactions, as in the chelation of Ca2+ of blood by EDTA, which thus acts as an anticoagulant.

Clotting Factors: Clotting factors are plasma that guides the thinning and clotting of blood. Many are known only by Roman numerals (1-13). Their simple names contradict the importance of their role in clotting. One of the clotting factors, factor XI, contributes to the formation of an enzyme that plays an important role in the development of a protein called fibrin, a key clotting agent in the blood.

Clotting Time: Is the time required for you to stop bleeding or for your blood to clot.

Coagulation: Coagulation is a complex physiological cascade of enzymatic reactions in response to an injured blood vessel that result in a fibrin clot.

Coagulation Factor: Any of the various plasma components involved in the clotting process. There are 13 "factors" in the blood that can make it clot.

Coagulopathy: is a defect in the body’s mechanism for blood clotting, causing susceptibility to bleeding.

Colloids: A type of nondisfusable intravenous fluid used to maintain circulation volume in the body. Examples are albumin, dextran, hetastarch, tetrastarch, and gelatin (not available in the US).

Complement Cascade: Eleven specific enzymatic proteins occurring in normal serum which interact and destroy (not all complements destroy) foreign cells.

Connective Tissue: The supporting or framework tissue of the body, formed of fibrous and ground substance with more or less numerous cells of various kinds; it is derived from the mesenchyme, and this in turn from the mesoderm; the varieties of connective tissue are: areolar or loose; adipose; dense, regular or irregular, white fibrous; elastic; mucous; and lymphoid tissue; cartilage; and bone; the blood and lymph may be regarded as connective tissues the ground substance of which is a liquid.

Coumadin TM (Warfin): An anticoagulant that causes your clotting time to be prolonged. Used after surgeries when there is concern about clots forming and causing problems.

CPB: Cardiopulmonary Bypass.

CPD: Citrate Phosphate Dextrose, and anti-coagulant additive.

Cryoprecipitate: A plasma blood fraction used to treat deficiencies of Factor VIII, and fibrinogen in the treatment of Hemophilia A. The product is made by thawing frozen plasma at 4°C which results in a precipitate. This precipitate is removed and is named "cryoprecipitate".

Crystalloids: A type of intravenous fluid made up of various dissolved salts and sugars. These fluids are used to help maintain circulating blood volume.

D [TOP]

Deoxygenated Blood: Is blood that’s low in oxygen because it has released it to the body tissues.

Deoxyribonucleic Acid (DNA): The type of nucleic acid containing deoxyribose as the sugar component and found principally in the nuclei (chromatin, chromosomes) and mitochondria of animal and plant cells, usually loosely bound to protein (hence the term deoxyribonucleoprotein). It’s considered to be the autoreproducing component of chromosomes, including many viruses, and the repository of hereditary characteristics. Chromosomes are composed of double-stranded DNA; mitochondrial DNA is circular.

Desmospressin: shortens the prolonged activated partial thromboplastin time and the bleeding time. These effects probably result from the increases in factor VIII and vWF, which play a rate-accelerating role in these global tests of intrinsic coagulation and primary hemostasis.

Dextran: An intravenous fluid used as a plasma volume expander.

Diffusion: The random movement of particles from an area of greater concentration to one of a lower concentration.

Diphosphoglycerate: A chemical in the blood that attaches to the hemoglobin molecule and helps the hemoglobin release oxygen to the tissues and grab oxygen in the lungs.

Disseminated Intravascular Coagulation (DIC): A hemorrhagic syndrome that occurs following the uncontrolled activation of clotting factors and fibrinolytic enzymes throughout small blood vessels; fibrin is deposited, platelets and clotting factors are consumed, and fibrin degradation products inhibit fibrin polymerization, resulting in tissue necrosis and bleeding.

DNA: Abbreviation for deoxyribonucleic acid.

E [TOP]

ECMO: Extracorporeal Membrane Oxygenation.

Electrocautery: Cauterizes tissue using electric current to reduce or stop bleeding.

Endothelium: A layer of flat cells lining especially blood and lymphatic vessels and the heart. Bleeding occurs when these cells are torn or ruptured until a clot forms.

Erythroblasts: The first generation of cells in the red blood cell series that can be distinguished from precursor endothelial cells.

Erythrocyte: A mature red blood cell. It contains hemoglobin and oxygen.

Erythroid Progenitor Cells: A cell that will become a red blood cell.

Erythropoiesis: The formation of red blood cells.

Erythropoietin: A sialic acid-containing protein that enhances red cell production by stimulating formation of proerythroblasts and release of reticulocytes from bone marrow; it is formed by the kidney and liver, and can be detected in human plasma and urine. Its function is to stimulate the bone marrow to produce more red blood cells.

Extracorporeal Circulation: Diversion of blood flow through a circuit located outside the body but continuous with the bodily circulation.

F [TOP]

Factor IX: Participates in the clotting of blood. It is found in the plasma. Required for the formation of intrinsic blood thromboplastin and affects the amount formed (rather than the rate). Deficiency of factor IX causes hemophilia B.

Factor Vll: Is essential for blood to clot. It is found in the plasma. It accelerates the conversion of prothrombin to thrombin, in the presence of tissue thromboplastin, calcium, and factor V.

Factor VIII: Participates in the clotting of the blood by forming a complex with factor IXa, platelets, and calcium and enzymatically catalyzing the activation of factor X. It is found in the plasma. Deficiency of factor VIII is associated with classic hemophilia A. A deficiency of factor VIII can lead to impaired blood coagulation.

Factor XII: Participates in the clotting of blood, also known as plasma thromboplastin antecedent. It is found in the plasma. Deficiency of factor XI results in a hemorrhagic tendency and is caused by an autosomal recessive gene.

Ferritin: An iron-protein complex, containing up to 23% iron, formed by the union of ferric ions with apoferritin; it is found in the intestinal mucosa, spleen, bone marrow, reticulocytes, and liver, and regulates iron storage and transport from the intestinal lumen to plasma.

Fibrin: An elastic filamentous protein in the blood that cannot be dissolved and which forms clots along with platelets. It is composed from fibrinogen, which under influence of thrombin forms fibrin monomers that polymerise to fibrin polymers. The polymers form threads and a network that binds the surrounding fluid. Under influence of factor XIII the fibrin polymers interconnect through a binding of a glutamine and a lysine side chain and become as such insoluble.

Fibrinogen (Factor I): A protein of the blood that is necessary for the blood to clot.

Fibrinoysis: The process of splitting fibrin into smaller pieces as the blood clot is being dissolved.

Fresh Frozen Plasma: The fluid portion of one unit of human blood that has been centrifuged, separated and frozen solid at -18°C (-0.4°F) (or colder) within 8 hours of collection.

G [TOP]

Gammaglobulin: A protein precipitated from plasma (or serum).

Glycoprotein IIb/IIIa: a platelet surface receptor that is target by a class of drugs known as G IIb/IIIa inhibitors that inhibit and prevent platelet aggregation and thrombus formation.

H [TOP]

Haptoglobin: A group globulins in human serum that combine with hemoglobin, preventing hemoglobin loss in the urine.

Heart-Lung Pump: The heart-lung pump is used in heart surgery to recirculate and oxygenate the patient’s own blood. At a crucial point during heart surgery, the surgeon will direct the patient’s blood from the heart to the pump through tubing. The pump circulates the blood until the time when the surgeon is ready to redirect it back to the patient. This recirculation of blood allows the surgeon time to work on the vessels and the heart without the full flow of blood.

Hematinic: An agent that improves the quality of blood by increasing the number of erythrocytes and/or the hemoglobin concentration.

Hematocrit: Percentage of the volume of a blood sample occupied by red blood cells.

Hematology: The medical specialty that pertains to the anatomy, physiology, pathology, symptomatology, and therapeutics related to the blood and blood-forming tissues.

Hematopoietic Agents: Natural or artificial chemicals used to stimulate blood-cell growth and development.

Heme: The porphyrin chelate of iron in which the iron is Fe(ll) (or Fe2+); the oxygen-carrying, color-furnishing, prosthetic group of hemoglobin.

Hemochromatosis: A disorder of iron metabolism characterized by excessive absorption of ingested iron, saturation of iron-binding protein, and deposition of hemosiderin in tissue, particularly in the liver, pancreas, and skin; cirrhosis of the liver, diabetes (bronze diabetes), bronze pigmentation of the skin, and, eventually heart failure may occur; also can result from administration of large amounts of iron orally, by injection, or in forms of blood transfusion therapy.

Hemodilution: Removal of a specific amount of blood during surgery, replaced with intravenous (IV) fluids, and returned after surgery. This means the blood loss during surgery will contain less erythrocyte (red blood cells) and more water. Doing so will effectively reduce the amount of blood lost during surgery. This technique is only applicable in large surgery in which a high quantity of blood loss is expected.

Hemoglobin (Hgb): The protein found in red blood cells that transports oxygen from the lungs to the tissues where the oxygen is readily released and C02 from the tissues to the lungs where it is released.

Hemolytic Disease of the Newborn: A condition resulting from differences between the fetus’s blood group and that of the mother’s.

Hemophilia: An inherited disorder of blood coagulation characterized by a permanent tendency to hemorrhages spontaneous or traumatic, because of the result of a missing or a low amount of one of the clotting factors.

Hemorrhagic Disorder: Excessive or abnormal bleeding as a result of a disorder of the blood coagulation system.

Hemostatic Drug Therapy: Medications that assist with the clotting functions of blood. They make the blood clot better, which in large surgery or wounds with large amounts of blood loss, is necessary to prohibit further blood loss.

Hemostasis: The arrest of bleeding.

Heparin: A drug used to prevent blood from clotting.

Heparin Resistance: the failure to reach a certain ACT value after administration of heparin.

Hetastarch: An IV fluid used as a volume expander.

HITT: Heparin Induced Thrombocytopenia. Is the development of low platelet count due to the administration of various forms of heparin.

Homologous Blood Product: Blood product obtained from a donor other than the patient. These can be divided in packed cells (red blood cells), thrombocytes, plasma (the watery fluid of the blood without the cells), clotting factors.

Hormone: A chemical substance formed in one organ or part of the body and carried in the blood to another organ or part.

Hypercoagulable Disorders: Disorders or diseases characterized by abnormally increased coagulation.

Hypervolemia: Abnormally increased volume of blood.

Hypovolemia: A decreased amount of blood in the body.

I [TOP]

IBBM: International Board of Blood Management.

Immunoglobulins: One of a class of structurally related proteins, antibodies. Classified (in order of relative amounts present in normal human serum) as IgG (80%), IgA (10-15%), IgM (5-10%), IgD (less than 0.1%), and IgE (less than 0.01%).

Intraoperative: Is during surgery or within surgery.

Intra-operative Blood Cell Recovery and Reinfusion: The process of collecting blood lost during surgery and returning it to the patient after being appropriately processed.

Iron: A metallic element that occurs in the heme of hemoglobin, myoglobin, transferrin, ferritin, and iron-containing porphyrins.

Iron Therapy (oral and intravenous): Therapy with high doses of Iron, a mineral essential for the formation of red blood cells, especially for the formation of hemoglobin. This therapy is used in iron depletion anemia and before surgery, in which large amounts of blood loss are expected, to enhance the condition of the patient and the hemoglobin level. It is frequently combined with erythropoietin. The use of this therapy effectively reduces the risks of blood loss by increasing the oxygen transport capacity of the blood.

K [TOP]

Kidney: One of the paired organs that excrete urine. The kidneys are bean-shaped organs (about 11 cm long, 5 cm wide, and 3 cm thick) lying on either side of the vertebral column, posterior to the peritoneum, about opposite the twelfth thoracic and first three lumbar vertebrae.

L [TOP]

Leukocytes: White blood cells, or leukocytes, are cells of the immune system defending the body against both infectious disease and foreign materials.

M [TOP]

Major Blood Fractions: The major components of whole blood – red blood cells, white blood cells, plasma, platelets.

Microsampling: Technique that restricts the quantity or frequency of blood sampling for lab tests. In many cases, a complete run of tests can be done from only a few drops of blood. Typically, small vials are used for blood collection.

Mini-Circuit: CPB circuits that offer potential advantage in terms of reduced size and priming volume.

Minor Blood Fractions: Substances found in whole blood albumin, cryoprecipitate, immuneglobulin, clotting factors.

MUF: Modified Ultrafiltration.

Myelodysplastic Syndromes: A syndrome that in time may develop into overt leukemia. It is characterized by bone marrow dysfunction manifested by anemia, neutropenia, and thrombocytopenia.

N [TOP]

Non-wash Device: A system used during surgery to collect, filter, and reinfuse the patient’s blood back into the body.

Normal Saline: In medicine, normal saline (NS) is the commonly-used term for a solution of 0.9% of NaCI, or about 300 mOsm/L; It is also known as physiological saline or isotonic saline.

Normochromic: Being normal in color; referring especially to red blood cells that possess the normal quantity of hemoglobin.

O [TOP]

Oxygenated Blood: Is blood that is carrying oxygen.

Oxyhemoglobin: Hemoglobin in combination with oxygen, the form of hemoglobin present in arterial blood, scarlet or bright red when dissolved in water.

P [TOP]

Pentastarch: An IV fluid used as a blood volume expander.

Perfusion: The flow of blood through capillaries.

Peripheral Vascular Resistance: The resistance to flow of blood in the systemic circuit.

Phagocytic Cells: A cell possessing the property of ingesting bacteria, foreign particles, and other cells. Phagocytes are divided into two general classes: 1) microphages, polymorphonuclear leukocytes that ingest chiefly bacteria; 2) macrophages, mononucleated cells (histiocytes and monocytes) that are largely scavengers, ingesting dead tissue and degenerated cells.

Plasma: The fluid portion of the blood minus the red blood cells and white blood cells, and platelets.

Plasma Free Hemoglobin: Hemoglobin found in plasma due to rupture of red blood cells.

Plasminogen: An inactive form of plasmin, which is an enzyme in the blood that helps dissolve blood clots.

Platelet Rich Plasma (PRP): A concentrated source of autologous platelets, PRP contains and releases at least seven different growth factors that stimulate bone and soft tissue healing. Platelet-rich plasma is an alternative source of growth factors to promote wound healing.

Platelets: The small colorless disks in circulating blood which aid in blood clotting.

Polycythemia: An increase above the normal in the number of red cells in the blood.

Postoperative Blood Cell Recovery and Reinfusion: The process of collecting blood lost after surgery, and returning it to the patient after being appropriately processed.

Predonation: Donating your own blood prior to surgery. This practice may not reduce your risk of receiving ablood transfusion and may actually increase that risk because predonating makes the patient anemic, (see alsoAutologous Blood).

Pre-operative: before surgery takes place.

Post-operative: after surgery takes place.

Protein: Macromolecules consisting of long sequences of amino acids. Protein is three-fourths of the dry weight of most cell matter and is involved in structures, hormones, enzymes, muscle contraction, immunologic response, and essential life functions.

R [TOP]

RAP (Retrograde autologous priming): A technique for reducing hemodilution by removing crystalloid from the CPB circuit backwards from the aortic cannulation site.

Recombinant: In a laboratory setting, a cell or organism that has received genes from different parental strains.

Recombinant Erythropoietin: Erythropoietin made in the laboratory.

Recombinant Factor VIIa: A clotting factor which is manufactured through recombinant protein technology rather than from an allogeneic blood product. It is used to control bleeding and promote coagulation of blood.

Recothrom: Recombinant thrombin from a human source.

Red Blood Cells: Red blood cells (also called erythrocytes or RBCs) serve two important functions: they carry oxygen from the lungs to cells in all parts of the body and take carbon dioxide back to the lungs from the cells. Carbon dioxide is released as a waste product of cellular metabolism.

Reticulocytes: A young red blood cell. Such cells become more numerous during the process of active blood regeneration.

Ringer’s Lactate: An IV solution used primarily for volume expansion during acute blood loss.

S [TOP]

Sickle Cell Anemia: An autosomal recessive anemia characterized by crescent- or sickle-shaped erythrocytes and accelerated hemolysis, due to substitution of a single amino acid (valine for glutamic acid) in the sixth position of the *-chain of hemoglobin the gene of which is on chromosome 11. Develop “crisis” episodes of severe pain due to microvascular occlusions, bone infarcts, leg ulcers, and atrophy of the spleen associated with increased susceptibility to bacterial infections, especially streptococcal pneumonia.

Stem Cell: A cell capable of forming all the cells in a person’s blood system.

Surface coating in CPB: coating on or in the extracorporeal circuit which reduces complement activation of the blood when it comes into contact with the circuit.

Synthetic Erythropoietin: A hormone that stimulates production of red blood cells in your bone marrow.

T [TOP]

Tetrastarch: 3rd generation Hydroxethyl starch which falls under the category of colloidal volume expanders with lower molecular weight.

Thrombotic: Relating to, caused by, or characterized by clotting within a blood vessel.

Thrombin: Human-derived or synthetic products that can be used in surgery to support the body’s ability to clot and reduce bleeding (see also Adhesives).

Thrombelastography (TEG) is a method of testing the efficiency of coagulation in the blood. It was first developed by the German Dr.Hellmut Hartert at University of Heidelberg School of Medicine in 1948. It is especially important in surgery and anesthesiology.

Tissue Adhesives: Tissue Adhesives or surgical glue are a combination of the fibrinogen and thrombin mixed with the drug aprotinin. Tissue adhesives can be helpful in trauma when specific organ(s) (liver, spleen, and pancreas) are losing blood. The mixture is sprayed or painted on the organ(s) during surgery to stop or slow blood loss.

Transferrin: A non-heme globulin of the plasma, capable of acting as an iron-transporting protein.

V [TOP]

VAD: Ventricular Assist Device.

Vascular System: The cardiovascular and lymphatic systems collectively better known as the circulatory system.

Volume Expanders: Intravenous fluids made with water, salts, sugars or starched that help maintain the correct amount if fluid in the blood vessels (ie. the crystalloids – normal saline, lactated Ringer’s solutions and the colloids –tetrastarch, albumin, hetastarch).

VVA: Venous Vacuum Assist.

W [TOP]

White Blood Cells: Colorless blood cells that fight infection.

Z [TOP]

Z-Buff: Zero-balanced Ultrafiltration.

Health Park is the only hospital in our area to offer this lifesaving, revolutionary procedure.

“This really is exciting. This is perhaps the most revolutionary thing in heart surgery in the 27 years I’ve been performing surgery,” said. Dr. Brian Hummel, a surgeon.

It’s called Transcatheter Aortic Heart Valve– TAVR for short.

For it to work, a catheter is placed through the femoral artery in the groin to the heart.

High definition cameras and a state of the art X-ray machine help doctors navigate their way.

Once in place, the artificial valve is opened and begins to function.

The surgery is done in half the time– without even opening the chest.

This is the first operating room of its kind in our area, potentially helping thousands of people.

The first TAVR surgery in Southwest Florida is set to take place on Thursday.

This is only available to patients who can’t have open heart surgery.

“What we’re trying to do is to address those patience who are extremely high risk and might not be a candidate for the typical procedure and that’s where this is a tremendous advance,” Dr. Hummel said.

Treatment with TAVR is expected to increase a patient’s survival rate by 30-40% over a five year period.

Also, post-operative recovery period is significantly shorter than an open heart procedure.

TAVR patients recover within 1-2 weeks, while a traditional recovery takes 3-4 weeks.

Read the Full Article From WINK News

Introduction 

The necessity of blood conservation and the avoidance of using Allogeneic blood (donor blood) has grown tremendously in the past few years.  The danger of using banked blood has been recognized and there is a growing move to find new ways to conserve blood.  There is inherent risk of transmitting certain diseases and immunosuppression is unavoidable.  Practitioners are now aware that non-screenable transmittable diseases are a risk when allogeneic blood is given.  With this new awareness, blood use has dropped considerably and will continue to fall as new conservation techniques are devised.  Much of the decreased blood usage has come from perfusionists developing and utilizing ways to remove all blood from the perfusion circuit at the end of the case.  Manufacturers have also contributed to this reduction in allogeneic blood use.  Lower prime oxygenators, condensed circuits and other equipment are fast becoming the routine.  The standard of care has now become one that uses all measures to prevent allogeneic blood use.  Blood banks have benefited from decreased usage by having more blood available for emergencies.  Patients have benefited with reduced exposure to the hazards inherent in banked blood. This article focuses primarily on perioperative blood management techniques which can be implemented in cardiac surgery.

• Blood Management Summary Video
• Blood Management: The Future is Now
• Patient Blood Management: The Truth
• Blood Management in Cardiac Surgery

Blood Management Program

The cornerstone of all blood conservation efforts should be a well-conceived, multidisciplinary, multimodality approach to blood conservation.  Such an approach should incorporate documented policies and procedures, rigid transfusion criteria, evidenced-based techniques (described herein) and most importantly the organization of a blood management committee to oversee all aspects of the program.  Individuals participating on the blood management committee should include physicians, blood bank directors, nursing supervisors and perfusionists.  It is recommended that individuals participating on the committee obtain certification from the International Board of Blood Management (IBBM) to become certified Perioperative Blood Management Technologists (PBMT) or Perioperative Blood Management Specialists (PBMS).

Autologous Blood

The patient’s own blood, autologous blood, eliminates many of the disadvantages of allogeneic blood.  Many patients will accept their own blood, but will not accept transfusions of allogeneic blood.  Some adherents to the Jehovah’s Witnesses religion will allow this type of transfusion.  As mentioned above, the risk of disease transmission is eliminated.  Cross-matching errors are also eliminated with the use of autologous blood.  Some patients are difficult to obtain blood for if they have multiple red blood cell antibodies or unusual blood phenotypes.  There are several ways that the patient’s blood can be salvaged and returned to the patient.

Autologous Blood Donation

The patient can donate his or her blood in preparation of a major surgery.  The procedure is excellent for non-emergent cases where there is enough time to employ the technique.  The patient’s blood is collected gradually over the weeks before surgery.  The patient is brought in every two weeks and a small amount of blood is removed and stored.  The total amount collected this way is usually about the equivalent of 2 units of packed red blood cells.  Major drawbacks of this system are the time and numerous visits required to accumulate a sufficient amount of blood.  Costs of drawing and storing the blood can also be considerable.

In heart surgery, another method of obtaining the patient’s blood can be adopted.  Blood can be removed just prior to starting cardiopulmonary bypass (CPB).  After heparinization and cannulation, blood can be removed by way of the venous line and a Y connection to a collection bag.  The venous line is unclamped and the priming volume is allowed to enter the venous reservoir.  When the patient’s blood reaches the Y connection, a clamp is applied and the blood is diverted to the collection bag.  The patient can be infused through the arterial cannula to maintain adequate arterial blood pressure.  The process is done slowly to prevent arrhythmias and drops in blood pressure.  One of the safety features of this technique is that, in most cases, CPB can be initiated immediately if the patient becomes unstable.  The patient is heparinized for the bypass procedure before the blood is removed, therefore the blood is fully anticoagulated when giving back to the patient after CPB.  Heparin in this blood must be taken into consideration when the protamine reversal dose is given.  The blood collected this way retains all clotting factors. This blood contains platelets that will not be exposed to the pump circuit and bypass.  Some teams perform ANH or Acute Normovolemic Hemodilution and remove blood from the central line or 14 gage IV line and replace this blood with a colloid.  Removing blood in this manner can require more time but also eliminates the safety of being able to initiate CPB if done before cannulation.  Blood saved before CPB is begun and reinfused after CPB has been shown in some studies to decrease post-op bleeding and coagulation defects.  This method is valuable in preventing allogeneic blood administration.  The problem with removal of blood in the OR is that the patient must have a high enough hematocrit to allow removal of the blood.  With the dilution of CPB small patients or those with a low hematocrit are not candidates for this procedure.  Some surgeons are reluctant to use this method because of the dangers associated with ischemic heart disease.

Autologous Priming

In on-pump cardiac surgery, another technique can be employed which is essentially the opposite of collecting and saving pre-bypass autologous blood.  With this technique, the crystalloid in the CPB circuit is removed and replaced with the patient’s own blood just prior to initiation of CPB.  This method is called Autologous Priming, and it can decrease the amount of hemodilution that would normally take place upon initiation of CPB, thereby preserving the patient’s hematocrit.

Removal of the crystalloid via autologous priming can be done at virtually any point in the CPB circuit, however it must be done slowly and must be carefully coordinated with anesthesia in order to ensure that the patient’s blood pressure is not compromised.  The recirculation line on the oxygenator is the most commonly used site for removal of the crystalloid.  Blood from the patient is allowed to flow into the CPB circuit from either the venous line (Autologous Priming) or retrograde from the aortic line.  When done in the retrograde fashion from the aortic line, it is typically termed Retrograde Autologous Priming or “RAP” for short.  The displaced crystalloid can be collected in a bag or diverted to the cell saver for processing.  Either way, the volume of the displaced crystalloid should be measured and subtracted from the initial priming volume for fluid balance calculations.  Autologous priming is most effective on patient’s who have sufficient volume to tolerate the removal of 500ml-1500ml or their blood volume.  Patients with high pulmonary pressures and enlarged hearts tend to tolerate the procedure particularly well.  In the event that there is insufficient volume to operate the heart lung machine safely after initiation of CPB, the removed crystalloid can always be returned to the CPB circuit.

Autotransfusion Machine (Cell Washer)

These machines have become common place in heart surgery and their employment is likely to increase as new uses are conceived.  These machines allow the salvage of blood that is apparently lost.  Blood on the surgical field can be aspirated with a special suction line into a holding cardiotomy.  In addition, blood remaining in the CPB oxygenator and circuit, can be salvaged at the end of the operation.  Blood can also be aspirated from post- op drainage devices such as chest tube collection containers.

The main functions of the cell saver are collection in a heparinized container, concentration of the fluid via centrifugation, washing the red cells and diverting the washed RBCs to an infusion bag (See Animation Below).  The aspiration tube used to suction blood from the surgical field is a double line with heparinized saline constantly dripping down the line and back to the collection cardiotomy with the aspirated blood and fluid.  The central component of the processor is the centrifugal bowl, known as a Latham bowl or Baylor bowl.  Fluid from the cardiotomy containing blood enters a tube in the middle of the spinning bowl and travels to the bottom.  The fluid moves to the outside where the heavier red blood cells separate and concentrate.  The leukocytes and platelets form a buffy coat layer on top of the red blood cells.  The plasma including clotting factors, plasma proteins and waste fluid accumulate on top of this layer.  An exit tube on top of the bowl allows the plasma and effluent waste to leave the bowl to a waste bag.  A sensor recognizes when the red blood cell level has risen to the top of the bowl and a wash with normal saline begins.  The normal saline wash removes any debris or other harmful elements.  It is important not to use sterile water for this wash as hemolysis would occur due to the hypotonicity of the water.  Next, the blood is emptied to a holding bag for reinfusion.

The hematocrit of the processed cells suspended in saline is over 50% (possibly as high as 70%).  The  volume of a processed bowl in the adult set is 225 ml.  Smaller bowl sizes are available for pediatric patient’s or low blood loss procedures.  The effluent that is removed contains platelets, plasma fractions, leukocytes, free hemoglobin, heparin, saline and debris.  The blood should be infused through a filter within 6 hours of salvage if kept at room temperature.  A danger of the use of the processor is that insufficient washing may leave heparin in the red blood cells to be reinfused and bleeding may result.  Slow washes are better than fast washes for removing contaminants.  Often large volumes are processed in cases of massive bleeding and it should be remembered that the product returned is devoid of platelets and clotting factors.  It would be necessary, in this case, to also administer platelets and fresh frozen plasma.

Contraindications of Processor Use:

• Gross contamination or Infection
• Malignancy of the surgical area
• Cesarean Section (Amniotic fluid should not be aspirated.)
• Use of topical hemostatic agents

Hemostatic Agents That Preclude Processor Use:

• Antivene
• Gelfoam
• Helistat
• Hemopad
• Instat

Detrimental Factors Affecting Processor Use:

• Antibiotics aspirated should be washed slowly and thoroughly.
• Betadine solution should not be aspirated due to hemolysis.
• Hot solutions should not be aspirated due to hemolysis.

Other Uses of Blood Processors:

Uses of these machines other than the traditional blood salvaging have increased recently.  Blood left in the pump circuit can be salvaged.  The blood can be pumped through the arterial cannula after the case into the processor sucker.  There the blood enters the reservoir and can be processed.  It is necessary to flush the circuit with priming solution to remove all the blood.  This leaves a pump and circuit that is primed and ready to use in case of the reinstitution of CPB.  The blood salvaged from the circuit is excellent for processing due to the lack of contamination and debris. The only drawback is the loss of platelets, plasma proteins and clotting factors.

Relatively new advancements in the field of autotransfusion are devices which allow for automatic processing of wound drainage postoperatively.  These devices are capable of processing, washing and returning shed blood that is suctioned from surgical drains postoperatively.  These devices are particularly effective in cardiac surgery, where postoperative blood loss can be significant.  An example of such a device is the CardioPAT manufactured by Haemonetics Corporation.

Use as a rapid infusion device is another capability of processors.  The processor tubing is adapted by disconnecting the tube before it enters the centrifugal bowl.  This tubing can be connected to a 1/4 in. line that leads to various IV sites for infusion.  The air detector with automatic stop makes an excellent safety feature during this adaptation.  The speed of the pump should be low to avoid over-pressurizing the IV sites.

Plasmapheresis and Plateletpheresis

Plasmapheresis and plateletpheresis are terms used to describe the removal of those portions from whole blood while separating the red blood cells and giving them back to the patient.  The products may then be given to the patient after bypass.  The purpose of this procedure is to conserve the platelets and other clotting factors while not reducing the hematocrit of the patient during bypass.  The processor is used for this procedure.  Uncontaminated blood is drawn into the centrifuge where it is spun to separate the products.  The products are collected in transfer bags where ordinarily the waste liquid is contained and the red blood cells are collected as usual.  The collected RBCs can be given back immediately or held until later.

Hemoconcentrators 

Excess fluid can be removed from the patient’s vascular system with a hemoconcentrator.  The hematocrit of the patient will increase as the fluid is removed.  During CPB these devices may be connected to the pump circuit and are a great asset for fluid management.  There are no absolute contraindications to the use of these devices as there are with the autotransfusion blood processors-washers.  Perfusionists do not ordinarily use the dialysate irrigating solution to affect electrolyte control.  The fluid removed is plasma water along with solutes.  Other solutions can be added to the pump volume to control electrolyte concentrations if necessary.  This is often used for control of potassium.  Plasma water, potassium and other electrolytes are removed and normal saline is added to reduce the amount of circulating potassium.  If a normal saline irrigating dialysate was used  the process might be faster because the gradients of solutes in the solution and the blood would be different.  However, this is usually not necessary during CPB.

The hemoconcentrator works by forcing fluid and small solutes across a semi-permeable membrane.  The formed elements of the blood are too large to cross this membrane.  Globulins and other large proteins (fibrinogen and albumin) are also not removed.  The sizes of the pores range from 15,000-55,000 daltons and this allows sodium, potassium, chloride, creatinine, urea and glucose to cross the membrane for removal.  Heparin can also be removed or concentrated in small amounts.  The size of heparin is 6,000-20,000 daltons, therefore a portion will cross the membrane and activated clotting times should be monitored often.  The amount of circulating drugs may be decreased by the removal of the plasma and this should be considered when determining the patient’s response to medications.

There are many places to incorporate the device in to the pump circuit.  Some perfusionists let the pressure of the arterial line provide the pumping force to remove the fluid.  This is done by a Y connector and tubing coming off the arterial line.  Pump flows should be increased to account for the flow that is diverted to the hemoconcentrator.  Care should be taken to clamp this line when the pump flow is decreased due to the backflow that can occur.  Other perfusionists desire a dedicated pump head to control the flow through the hemoconcentrator.  This allows more control and avoids problems with diminished arterial pump flow.  The disadvantage of this technique is that it requires a pump head for use.  A way to have the ability to quickly utilize a hemoconcentrator is to have a Y connector with a short length of tube built into the pump circuit.  This tube comes off the arterial line and is kept clamped if use of a hemoconcentrator is not needed.  If it becomes necessary to hemoconcentrate, one can be connected quickly to the tube.

The residual blood left in the pump circuit can be salvaged and concentrated with the hemoconcentrator after CPB is completed. New technologies such as separate hemoconcentrating reservoirs allow for quick, safe and  reproducible blood salvaging with quality control and also keep the circuit safely primed with chased crystalloid fluid. An example of such a device is the Hemobag manufactured by Global Blood Resources LLC. Alternative methods can be used where the blood is circulated through joined arterial and venous lines or through an A-V bridge and the hemoconcentrator is allowed to filter till you get to the bottom of the venous reservoir.

Just recently, I had the honor and the privilege of touring and meeting some of the key stakeholders at Lexington Medical Center Laboratory Services in Columbia, South Carolina. I met with the Clinical Lab Director, Administrative Lab Director and the Transfusion Service Supervisor. Their enthusiasm, knowledge and excitement in setting up a Blood Management program are what inspired me to write this newsletter. Yes, we may call them “lab rats”; but to me they are the “Mighty Mouse” of a multi-disciplinary Blood Management team. These clinicians are focused on quality and accurate results.

Over the course of many years, I have dedicated myself to setting up Blood Management programs at multiple hospitals. I have been blessed with the support of laboratory services in all of these programs. Together we have won multiple awards for quality and safety in patient care. Yes, many hospitals have Transfusion Committees; but once they see the overall scope of a Blood Management program, they realize this is not the same animal. Let’s focus on some of the vital subjects in which Laboratory Services contribute to a Blood Management program.

Data is one of the key factors in a Blood Management program. This data includes: STS data, product evaluation data, study data and most importantly blood product utilization data. In working with Laboratory Services and Blood Bankers over the years, we have derived algorithms and excel charts to track blood product usage. This data provides the Blood Management Team with the ability to track the overall success of the program. It not only gives us the direct cost, but also the overall utilization cost of transfusion therapy.

Point of care (POC) is another key weapon in a successful Blood Management Program. POC includes everything from coagulation analyzers (TEG), gas analyzers (Epocal), to even anticoagulation monitors (Hepcon). These systems must be set up properly with education, validation and quality controls to work successfully. Laboratory service in conjunction with Perfusion Services working together can make this happen.

Forms, documents, policies and procedures are another valuable and crucial part of Blood Management. Hospitals are now under the watchful eye of Joint Commission, CLIA and AABB in regard to their Blood Management practices. Joint Commission just recently released its seven new guidelines on Blood Management. These guidelines range from obtaining the proper consents to physician orders in blood products. Something as simple as “Type & Screen” versus “Crossmatch” education can be a huge contributory factor to a Blood Management program. In many of these institutions, we have reviewed, rewritten and revamped all these documents to meet state and federal guidelines. Again, Lab and the Blood Management team working in alliance can make the difference.

Blood providers, working together with the Lab and Blood Management team are also key stakeholders. Remember, there are blood shortages nation-wide. By setting up successful blood drives, we can have the blood products we need and reduce the cost in contract negotiations. The Lab can also develop efficient notification forms when shortages arise.

In conclusion, the lab and blood bank are a vital part of the Blood Management program. My relationship with them in every organization has been stellar. Like “Mighty Mouse” when you call, they respond, and this may save your day.

Please feel free to provide feedback, or if you have any other questions or comments, to Perfusion.com regarding this topic or any other topic you would like to see presented here.

Best Regards,

C. Ty Walker, CPBMT, CCP
Blood Management Director
Perfusion.com, Inc.
twalker@perfusion.com

“Health care organizations that contract with Perfusion.com, Inc. can look to this certification as an assurance that they demonstrate a commitment to providing and continuously improving quality services,” says Michele Sacco, M.S., executive director, Health Care Staffing Services Certification, Joint Commission.

The ongoing shortages of nurses, pharmacists and other health care professionals have forced health care organizations to increasingly fill positions with temporary workers through contractual arrangements with staffing firms. The Joint Commission’s certification program, launched in October 2004, offers an independent, comprehensive evaluation of a staffing firm’s abilities to provide competent staffing services.

“Certification recognizes Perfusion.com’s dedication to providing exceptional perfusionists that are qualified to provide safe, high-quality care to patients,” says Bryan V. Lich, President. “We’re proud to receive the Joint Commission’s Gold Seal of Approval™.”

Founded in 1951, The Joint Commission seeks to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. The Joint Commission evaluates and accredits more than 17,000 health care organizations and programs in the United States, including more than 9,500 hospitals and home care organizations, and more than 6,300 other health care organizations that provide long term care, behavioral health care, laboratory and ambulatory care services. In addition, The Joint Commission also provides certification of more than 1,000 disease-specific care programs, primary stroke centers, and health care staffing services. An independent, not-for-profit organization, The Joint Commission is the nation’s oldest and largest standards-setting and accrediting body in health care. Learn more about The Joint Commission at www.jointcommission.org.

In 1998, Perfusion.com began providing temporary perfusion services on short-term notice to hospitals throughout the United States.  The demand for this service grew steadily as the cardiac surgery climate evolved in the late 1990’s.  During this time, we continued to develop our website, which became the leading informational resource for the world’s perfusionists.  We also published The Manual of Clinical Perfusion, which is now an integral part of the didactic curriculum at every perfusion education program in the United States.

By 2002, Perfusion.com was well established as a provider of short-term perfusion services.  In response to market demand, the service base expanded to include long-term perfusion service.  Our corporate mission, “to provide the highest quality perfusion services to our patients and customers” was the foundation from which our continued growth in market share was attained.  This mission remains upheld via company-wide commitment to quality and realized through a proactive management team, skilled clinicians, an evidence-based approach to practice management and ultimately through positive clinical outcomes.

Perfusion.com has grown organically over the years, and today our portfolio of services includes equipment sales, marketing services, employment services and perfusion services.  In addition, members of our management team provide consulting services and are frequently requested to serve as expert witnesses in legal matters involving cardiopulmonary bypass.  Perfusion.com occupies a unique position in the industry, as it is both an informational resource and a fully capable service and equipment corporation.  We firmly believe that our diversity is our strongest asset, allowing us to offer a board range of value-added services to our customers and insulates our core business from the inevitable changes facing the cardiac surgery market in the future.

There have been few companies that have survived unscathed during the last fifteen years in this industry with their original structure and leadership intact. With a clear vision, a sincere commitment to quality and a foundation built on substance rather than sales, Perfusion.com has endured.  With the global support of the perfusion community and a highly organized and motivated management team, Perfusion.com will continue to grow and evolve for many years to come.

Welcome to the Future of Continuing Education!  The Sanibel Symposium will be available via Live Webcast.  We will be using a browser-based streaming solution (WebEx) that is compatible with all web browsers and operating systems.  This will give Perfusion.COM members who are unable to attend our Symposium an opportunity to participate live and earn 24.8 CEU Category I Credits for their participation.  Webcast participants will be able to view the presenter simultaneously with the presentation (including video content within the PowerPoint Presentations), as well as join in with the discussion part of the program via live chat.   The price for the Live Webcast is $250 and can be purchased online via the link below.  Student and International Attendee discounts are available.

• Live Webcast Registration
• Live Conference Link (Available 2/16/2012)
• WebEx Download and Demo Conference