Blood management-issues: the panic of coagulopathic bleeding--is there a rational approach?

Blood management is an evolving field of reducing transfusions of allogeneic blood by maximizing multi-modality therapy to optimize red cell mass, reduce red cell loss, and harvest red cells that would have otherwise been discarded. These techniques are highly dependent upon teams working together. The programs are not just focused upon red cells but also on coagulation therapy. Coagulopathy is at times a difficult complex pathologic conundrum. In cardiac surgery the complexity is added to because of the inflammatory effects of anticoagulation, air/blood interfaces, and inflammation. Patients respond variably due to their own genetic and environmental factors. There can be a rational approach, thereby avoiding panic (a normal fear response) if the clinician utilizes not only the available laboratory technologies existing today but also follows published algorithms for treatment. These technologies with their coexisting algorithms have been widely shown to decrease blood usage, yet not to decrease bleeding. That finding suggests that therapy without such guidance wastes expensive pro-coagulant blood products and produces no advantage (a decrease in bleeding). When a therapy produces no advantage all that it leaves the patient with is the side effects or adverse outcomes. Adverse outcomes from coagulation products are real and sobering.