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Blood Loss in Open Heart Surgery: Correlation With Laboratory Tests of Hemostatic Function

Blood Loss in Open Heart Surgery: Correlation With Laboratory Tests of Hemostatic Function Abstract SEVERAL studies of the prevention and treatment of excessive bleeding in extracorporeal circulation have been published.1-17 While inadequate surgical hemostasis11,12,15 and incomplete heparin neutralization7,8,15-17 are the most common causes of hemorrhage, changes in the platelets and plasma coagulation factors do occur, but they only occasionally contribute to blood loss.2-8,10-14,16,17 For the past five years, all candidates for open heart surgery at the Toronto General Hospital have routinely had preoperative studies of hemostatic function. During the past year similar tests have also been performed at the completion of perfusion. This review was undertaken in order to determine the cause of excessive blood loss and to assess the ability of the preoperative hemostatic tests to predict operative hemorrhage. While major bleeding is now an infrequent complication after cardiopulmonary bypass at this hospital, a recent survey18 suggests that bleeding is still a major problem with some teams of References 1. Osborn, J.J., et al: Cause and Prevention of Hemorrhage Following Extracorporeal Circulation , Surg Forum 6:98, 1955. 2. Von Kaulla, K.N., and Swan, H.: Clotting Deviations in Man During Cardiac Bypass: Fibrinolysis and Circulating Anticoagulant , J Thorac Cardiov Surg 36:519, 1958. 3. Brown, I.W., Jr., and Smith, W.W.: Hematologic Problems Associated With the Use of Extracorporeal Circulation for Cardiovascular Surgery , Ann Intern Med 49:1035, 1958.Crossref 4. Hoeksema, T.D.D.; Mustard, J.F.; and Mustard, W.T.: A Study of Some Coagulation Factor Changes Occurring in Blood During Extracorporeal Circulation , Trans Amer Soc Artif Intern Organs 5:225, 1959. 5. Nilsson, I.M., and Swedberg, J.: Coagulation Studies in Cardiac Surgery With Extracorporeal Circulation Using a Bubble Oxygenator , Acta Chir Scand 117:47, 1959. 6. Gans, H., et al: Problems in Hemostasis During Open Heart Surgery: On the Changes in the Blood Clotting Mechanism During Cardiopulmonary Bypass Procedures , Ann Surg 155:353, 1962.Crossref 7. Bloom, A.L.: Activation of Coagulation and Fibrinogen Loss After Using an Extracorporeal Circulation , J Clin Path 16:558, 1963.Crossref 8. Sharp, A.A., and Eggleton, M.J.: Haematology and the Extracorporeal Circulation , J Clin Path 16: 551, 1963.Crossref 9. deGabriele, G.: Some Aspects of Haemostasis After Open-Heart Surgery , J Clin Path 16:569, 1963.Crossref 10. Britten, A., et al: The Use of ACD Bank Blood and Fresh Heparinized Blood in Open Heart Surgery: A Comparative Coagulation Study , Transfusion 3:368, 1963.Crossref 11. Phillips, L.L.; Malm, J.R.; and Deterling, R. A.: Coagulation Defects Following Extracorporeal Circulation , Ann Surg 157:317, 1963.Crossref 12. Wurzel, H.A.; Kirby, C.K.; and Spagna, P.: Coagulation Defects in Open Heart Procedures , Amer J Card 12:339, 1963.Crossref 13. Perasalo, O.; Ikkala, E.; and Telivuo, L.: Changes in Blood Coagulation Mechanisms During Extracorporeal Circulation , J Cardiov Surg 4:642, 1963. 14. Gollub, S.: Unexplained Bleeding in Cardiothoracic Operations , Ann NY Acad Sci 115:199, 1964.Crossref 15. Gilbert, J.W.; Bronson, W.R.; and Brecher, G.: Incidence of Bleeding in Cardiac Surgery With Extracorporeal Circulation , Ann NY Acad Sci 115: 302, 1964.Crossref 16. Dybkjaer, E.; Berg, E.; and Kissmeyer-Nielsen, F.: Coagulation Studies in Extracorporeal Circulation , Acta Chir Scand 128:350, 1964. 17. Blomback, M.; Noren, I.; and Senning, A.: Coagulation Disturbances During Extracorporeal Circulation and the Postoperative Period , Acta Chir Scand 127:433, 1964. 18. Jorgensen, R.L., and Dunn, F.L.: Hematological Problems of Heart-Lung Bypass, thesis, University of Nebraska College of Medicine, Omaha, Neb, 1965. 19. Dacie, J.V., and Lewis, S.M.: Practical Haematology , ed 3, London: J. A. Churchill Ltd., 1964. 20. Proctor, R.R., and Rapaport, S.I.: The Partial Thromboplastin Time With Kaolin: A Simple Screening Test for First Stage Plasma Clotting Factor Deficiencies , Amer J Clin Path 36:212, 1961. 21. Hardisty, R.M.; Dormandy, K.M.; and Hutton, R.A.: Thrombasthenia , Brit J Haemat 10:371, 1964.Crossref 22. Biggs, R., and MacFarlane, R.G.: Human Blood Coagulation and Its Disorders , ed 3, Oxford: Blackwell Scientific Publications, 1962. 23. Fearnley, G.R.; Balmforth, G.; and Fearnley, E.: Evidence of a Diurnal Fibrinolytic Rhythm: With a Simple Method of Measuring Natural Fibrinolysis , Clin Sci 16:645, 1957. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Blood Loss in Open Heart Surgery: Correlation With Laboratory Tests of Hemostatic Function

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Publisher
American Medical Association
Copyright
Copyright © 1966 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1966.01330020115019
Publisher site
See Article on Publisher Site

Abstract

Abstract SEVERAL studies of the prevention and treatment of excessive bleeding in extracorporeal circulation have been published.1-17 While inadequate surgical hemostasis11,12,15 and incomplete heparin neutralization7,8,15-17 are the most common causes of hemorrhage, changes in the platelets and plasma coagulation factors do occur, but they only occasionally contribute to blood loss.2-8,10-14,16,17 For the past five years, all candidates for open heart surgery at the Toronto General Hospital have routinely had preoperative studies of hemostatic function. During the past year similar tests have also been performed at the completion of perfusion. This review was undertaken in order to determine the cause of excessive blood loss and to assess the ability of the preoperative hemostatic tests to predict operative hemorrhage. While major bleeding is now an infrequent complication after cardiopulmonary bypass at this hospital, a recent survey18 suggests that bleeding is still a major problem with some teams of References 1. Osborn, J.J., et al: Cause and Prevention of Hemorrhage Following Extracorporeal Circulation , Surg Forum 6:98, 1955. 2. Von Kaulla, K.N., and Swan, H.: Clotting Deviations in Man During Cardiac Bypass: Fibrinolysis and Circulating Anticoagulant , J Thorac Cardiov Surg 36:519, 1958. 3. Brown, I.W., Jr., and Smith, W.W.: Hematologic Problems Associated With the Use of Extracorporeal Circulation for Cardiovascular Surgery , Ann Intern Med 49:1035, 1958.Crossref 4. Hoeksema, T.D.D.; Mustard, J.F.; and Mustard, W.T.: A Study of Some Coagulation Factor Changes Occurring in Blood During Extracorporeal Circulation , Trans Amer Soc Artif Intern Organs 5:225, 1959. 5. Nilsson, I.M., and Swedberg, J.: Coagulation Studies in Cardiac Surgery With Extracorporeal Circulation Using a Bubble Oxygenator , Acta Chir Scand 117:47, 1959. 6. Gans, H., et al: Problems in Hemostasis During Open Heart Surgery: On the Changes in the Blood Clotting Mechanism During Cardiopulmonary Bypass Procedures , Ann Surg 155:353, 1962.Crossref 7. Bloom, A.L.: Activation of Coagulation and Fibrinogen Loss After Using an Extracorporeal Circulation , J Clin Path 16:558, 1963.Crossref 8. Sharp, A.A., and Eggleton, M.J.: Haematology and the Extracorporeal Circulation , J Clin Path 16: 551, 1963.Crossref 9. deGabriele, G.: Some Aspects of Haemostasis After Open-Heart Surgery , J Clin Path 16:569, 1963.Crossref 10. Britten, A., et al: The Use of ACD Bank Blood and Fresh Heparinized Blood in Open Heart Surgery: A Comparative Coagulation Study , Transfusion 3:368, 1963.Crossref 11. Phillips, L.L.; Malm, J.R.; and Deterling, R. A.: Coagulation Defects Following Extracorporeal Circulation , Ann Surg 157:317, 1963.Crossref 12. Wurzel, H.A.; Kirby, C.K.; and Spagna, P.: Coagulation Defects in Open Heart Procedures , Amer J Card 12:339, 1963.Crossref 13. Perasalo, O.; Ikkala, E.; and Telivuo, L.: Changes in Blood Coagulation Mechanisms During Extracorporeal Circulation , J Cardiov Surg 4:642, 1963. 14. Gollub, S.: Unexplained Bleeding in Cardiothoracic Operations , Ann NY Acad Sci 115:199, 1964.Crossref 15. Gilbert, J.W.; Bronson, W.R.; and Brecher, G.: Incidence of Bleeding in Cardiac Surgery With Extracorporeal Circulation , Ann NY Acad Sci 115: 302, 1964.Crossref 16. Dybkjaer, E.; Berg, E.; and Kissmeyer-Nielsen, F.: Coagulation Studies in Extracorporeal Circulation , Acta Chir Scand 128:350, 1964. 17. Blomback, M.; Noren, I.; and Senning, A.: Coagulation Disturbances During Extracorporeal Circulation and the Postoperative Period , Acta Chir Scand 127:433, 1964. 18. Jorgensen, R.L., and Dunn, F.L.: Hematological Problems of Heart-Lung Bypass, thesis, University of Nebraska College of Medicine, Omaha, Neb, 1965. 19. Dacie, J.V., and Lewis, S.M.: Practical Haematology , ed 3, London: J. A. Churchill Ltd., 1964. 20. Proctor, R.R., and Rapaport, S.I.: The Partial Thromboplastin Time With Kaolin: A Simple Screening Test for First Stage Plasma Clotting Factor Deficiencies , Amer J Clin Path 36:212, 1961. 21. Hardisty, R.M.; Dormandy, K.M.; and Hutton, R.A.: Thrombasthenia , Brit J Haemat 10:371, 1964.Crossref 22. Biggs, R., and MacFarlane, R.G.: Human Blood Coagulation and Its Disorders , ed 3, Oxford: Blackwell Scientific Publications, 1962. 23. Fearnley, G.R.; Balmforth, G.; and Fearnley, E.: Evidence of a Diurnal Fibrinolytic Rhythm: With a Simple Method of Measuring Natural Fibrinolysis , Clin Sci 16:645, 1957.

Journal

Archives of SurgeryAmerican Medical Association

Published: Aug 1, 1966

References