7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
1/33
Hemostasis, Surgical Bleedingand
Transfusion
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
2/33
HemostasisHemostasis = to stop bleeding
4 Basic mechanism / phase
Vascular constriction
Platelet plug formation
Fibrin formation
Fibrinolysis
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
3/33
Vascular ConstrictionInjury to essel contraction smooth muscle
!ediators "
#hrombo$ane %&
at site of injury ia releasearachidonic acid from plateletmembranpotent constrictor smooth muscle
'ndothelinendhothelium(serotonin during
platelet agregation
potent asoconstictors#rombo$ane %& )#*%&+,
Brady-inin, Fibrinopeptides
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
4/33
Platelet Phase.ource mega-aryocyt marro
%nucleated, normaly remoe by splen,aerage lifespan 0123 day
Integral role hemostasis " forming hemostasisplug and contributing in thrombin formation
Injury intimal layere$poses colagen subendhotelial( factorplatelet adhere )release
%5P(serotonin+recruits other platelet fromcirculating blooddisrupt essel sealed )plateletagregation6brinogen binding the plateletsurface 7 strengthens platelet interactions
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
5/33
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
6/33
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
7/33
P8%#'8'# I. '*#9'!'8: I!P;9#%
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
8/33
CoagulationsInteraction endothelium ( platelet (
circulating coagulations factor
Intrinsic
no need for surface e$posure'$trinsic begin once essel is disrupted
Intrinsic(e$trinsic cascade merge into
common pathay on factor *
Prothrombinthrombinchange 6brinogen to6brin
!easurement aP##intrinsic factor, P## e$trinsic factor
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
9/33
Prothrombin circulating plasma proteins
Vit is re>uired for normal formation of
prothrombin
in lier
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
10/33
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
11/33
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
12/33
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
13/33
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
14/33
FibrinolysisPreent propagation of clot formation
2? feedbac- inhibition on the coagulation cacscade
&? 6brinolysis
%ims on reconstitution of blood @oInitiated as the same time clotting mechanism
!ain enAyme plasmincleaes 6brin ( degrade
6brinogen
tP% actiates plasminogen more eciently
bound to6brinplasmin is formed selectiely on the clot
Product " '1nodule and 51dimer
mar-er of thrombosis or other conditions in actiation of6brinolysis is present
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
15/33
Congenital Factor
5e6cienciesCoagulation factor de6ciencyFactor VIII hemo6lia %
Factor I*
hemo6lia B9ecessie autosomal disorders aect in male
Clinical seerity depend on measurable factorVIII or I* in plasma
%? Plasma factor leel D 2E " seereB? 11 2 G E " moderate
C? 11 G 3 E " mild
Platelet function still normal
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
16/33
Von illebrands disease
Common congenital bleeding disorders
%utosomal dominant disorders, and primarydefect is lo F
platelet disorders mucosal bleeding,easybruising?
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
17/33
%c>uired hemostatic
defectPlatelet abnormalities could be
Juantitatie or Juantitatie
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
18/33
%c>uired
hypo6brinogenemia5IC ac>uired syndrome characteriAed by
intraascular actiation of coagulation
Clotting mechanism e$cessie thrombinmicrothrombus formation
Vasculature damage depletion and consumptionof coagulation factor and platelet diusebleeding
Causatie.epsis, trauma, ascular disorder,obstetric complications, malignancy, imunologicdisorder, drugs, sna-e/insect, lier disease,shoc-, massie transfusion
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
19/33
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
20/33
%nticoagulation and Bleeding
.pontaneous bleeding can be complication ofanticoagulant therapi e$ hematuria,soft tissue
bleeding, intracerebral bleeding, s-in necrosis andabdominal bleeding?
KKKone of the 6srt symptoms of an underlying tumormay be bleeding in patient ith nticoagulation
therapy9apid reersal of anticoagulation can beaccomplished ith FFP in an emergent situation?
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
21/33
8ocal Hemostasis!echanical prosedurs
digital pressure in pro$imal or oerbleeding site is eectie
#hermal agent
achiees hemostasis by denaturation ofprotein result in coagulation
negatie grounding plate should be placebeneath the patient ti aoid seere s-in burn
#opical hemostasis thrombin deriate product direct te
conersion of 6brinogen to 6brin
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
22/33
#ransfusion2? Human red cell membrane " least 33
dierent antigen
&? fortunately, only the %B; and the 9h
systems are important in the majority ofblood transfusion
? History
Infection " Hepatitis B,C syphillis HIV12,&
H#8V1I,II
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
23/33
5ue to surgery or trauma not necessarilyre>uire transfusion
Improement in ;$ygen1Carrying Capacity
#reatment of %nemiaVolume replacement
Belo 0 g/d8 idely accepted
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
24/33
hole Blood
Ban-ed
9educe of intracelluler %5P 7 &,
disphosphoglycerate decrease o$ygen transport
Clotting factor relatiely stable adantage
'leated lactate, potassium and amonium
Volume replacement
Fresh
%dministered ithin &4 hours of its donation
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
25/33
Pac-ed 9ed Cells
Choice for most clinical situation
Concentrate suspensions of red blood cells canprepared by remoing most of supernatantplasma after centrifuge reduce reaction byplasma component
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
26/33
9ed Blood Cells Ideal for patients re>uiring red cells but not
olume replacement
;nly one G Increase ;&carrying
capacity%L' B8;;5 V;8M!'
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
27/33
By Centrifugation remoing supernatantplasmareduce reaction caused by plasmacomp
;ne unit increse appro$imately 2 g/d8
P9C Formula"
P9C olume = ? $ )Q Hb+ $ B
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
28/33
Platelet
#he indications thrombocytopenia >ualitatie and
>uantitatie c?b massie bloods loss and replacement ithplatelet1poor products,inade>uate platelet production
R prophylactic " plt?counts belo 23,3331&3,333
R prophylactic preoperatie " plt?counts belo 3,333
R!icroascular bleeding in surgical patient ith platelets
D 3,333R
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
29/33
FFP9esuscitation trauma1associated
coagulopathy
.ource of the itamin 1dependent factor andis the only source factor V
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
30/33
Indications for 9eplacement
2? improement in o$ygen1carrying capacity
&? treatment of anemia? olume replacement
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
31/33
and
Preoperatie 'aluation of hemostasis
Hb leel D 0 gr/dl associated morecomplications
Consider factor " presence cardiopulmonarydisease, type of surgery, li-elihood of surgicalblood loss
I!P;9#%
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
32/33
'aluation of '$cessie Intraoperatie
Bleeding during or post operatie innefecctie hemostasis,blood transfusion,
undetected hemostasis defect, consumptiecoagulopaty, and or 6brinolysis?
!assie blood tranfusion trombocytopenia
dilutional coagulopaty
7/24/2019 Schwartz's Hemostasis, Surgical Bleeding
33/33
#H%
Top Related