Blood component therapy in open heart surgery

Extensive bleeding still remains a major cause of morbidity and mortality in patients undergoing surgery despite the recent achievements in our understanding of hemostasis and availability of modern blood component therapy. In some surgical patients abnormally prolonged operative bleeding due to thrombocytopenia or thrombocytopathia may be corrected by the infusion of platelet concentrates. Evaluation of the requests for platelet transfusion therapy to prevent or to stop excessive thrombocytopenic bleeding should be based on clinical and laboratory data, underlying disease and availability of therapeutic products. In most instances of hemostatic alterations associated with cardiopulmonary bypass operations, the occasional bleeding episodes are related to platelet dysfunction rather than to plasma coagulation abnormalities. While the levels of coagulation factors are usually depleted, principally due to dilution with priming solutions for the oxygenator, only rarely the levels impairing hemostasis are reached. In the early days of open heart surgery, it was thought that freshly drawn whole blood was essential for these procedures but now a days, it seems that stored red blood cells are equally effective. Use of fresh frozen plasma (FFP) for replacement of coagulation factors during or after cardiopulmonary bypass only rarely is necessary, and mild to moderate abnormalities of coagulation factors can be tolerated without FFP transfusion. In the early stage of open heart surgery (late sixties) an average of 9 units of whole blood (freshly drawn) was used for each patient during and after cardiopulmonary bypass. Since that time, much attention has been focused on methods to reduce blood requirements for these patients. Hemodilution using a bloodless prime for the oxygenator is now widely used and has been found to be effective in reducing blood usage.(ABSTRACT TRUNCATED AT 250 WORDS)