Related Experiment Video

Updated: May 8, 2026

Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
05:23

Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload

Published on: March 14, 2017

Continuous hemoglobin monitoring during massive blood transfusion in a multivisceral pediatric transplant patient

Ankit Agrawal1, Amy B Beethe, James N Sullivan

  • 1Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE 68198-4455, USA.

Journal of Clinical Anesthesia
|August 23, 2013
PubMed

Insights

Continuous noninvasive hemoglobin monitoring may be unreliable during complex multivisceral transplants with abnormal physiology, rapid blood loss, and massive transfusions, despite appearing to correlate with trends.

Area of Science:

  • Transplant Surgery
  • Anesthesiology
  • Critical Care Medicine

Background:

  • A pediatric patient with a history of complex conjoined twin separation underwent a repeat multivisceral transplant due to organ failure.
  • The procedure involved liver, small bowel, pancreas, and kidney replacement.
  • Intraoperative complications included significant bleeding, coagulopathy, and acidosis.

Observation:

  • Continuous monitoring of hemoglobin (Hb) was performed using pulse co-oximetry.
  • Noninvasive Hb trends appeared to correlate with arterial Hb concentrations.
  • However, significant discrepancies were noted between noninvasive and intermittent blood gas analysis measurements.

Findings:

  • Pulse co-oximetry demonstrated poor agreement with direct arterial Hb measurements.
  • The noninvasive monitoring showed limitations in accuracy during this complex surgical case.
  • Reliability issues were pronounced given the abnormal physiology and rapid blood loss.

Implications:

  • Noninvasive hemoglobin monitoring may not be a reliable tool in high-risk transplant surgeries with hemodynamic instability.
  • Clinical decisions based solely on noninvasive Hb trends could be misleading.
  • Further research is needed to validate noninvasive monitoring techniques in critical surgical scenarios.

Keywords:
Blood transfusionKidneyLiverMulti-organ transplantationPancreasPediatric transplantation, small bowel

More Related Videos

Detection of Residual Donor Erythroid Progenitor Cells after Hematopoietic Stem Cell Transplantation for Patients with Hemoglobinopathies11:59

Detection of Residual Donor Erythroid Progenitor Cells after Hematopoietic Stem Cell Transplantation for Patients with Hemoglobinopathies

Published on: September 6, 2017

Related Concept Videos

Blood Transfusion and Agglutination02:45

Blood Transfusion and Agglutination

Blood transfusion is a therapeutic measure to restore the blood volume after extensive blood loss due to an accident or a medical procedure. Blood transfusion involves drawing a certain amount of blood from a suitable donor and infusing it into the recipient.
History
The history of blood transfusion dates back to the 17th century, when early attempts were made in animals. In 1818 James Blundell, a British doctor, performed the first successful human blood transfusion. Later in 1900, Karl...
Blood Transfusion01:15

Blood Transfusion

Blood transfusion is a critical medical procedure that saves lives and treats various medical conditions. It involves transferring blood from a donor to a recipient. This process requires a thorough understanding of the ABO blood group system and its associated antigens and antibodies.
Blood Transfusion Overview
A blood transfusion is a medical procedure used to replace blood lost due to injury, surgery, or to treat conditions such as anemia or cancer. During a transfusion, donor blood is...
Bone Marrow Sampling and Transplants01:22

Bone Marrow Sampling and Transplants

Bone marrow transplant is a potential cure for several diseases, including cancer and specific genetic disorders. Notably, this procedure is applicable for patients suffering from aplastic anemia, certain types of leukemia, severe combined immunodeficiency disease (SCID), Hodgkin's disease, non-Hodgkin's lymphoma, multiple myeloma, thalassemia, sickle-cell disease, and certain cancers.
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy the...
Kidney Transplant III: Nursing Management01:16

Kidney Transplant III: Nursing Management

Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
Hemodialysis II: Procedure and Complications01:24

Hemodialysis II: Procedure and Complications

DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
Continuous Renal Replacement Therapy01:30

Continuous Renal Replacement Therapy

Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...