J Gille — Page 4 | Search PubMed

PubMedDate not supplied

[Preoperative hypervolemic hemodilution with 6% hydroxyethyl starch 130/0,4 (HES 130/ 0.4) solution as a way of reducing needs for donor blood transfusion].

UNLABELLED: The efficacy of hypervolemic hemodilution (HHD) in reducing the rate of donor blood transfusion is controversely discussed. The present prospective, randomized, clinical study analyzes the impact of HHD with 6% hydroxyethyl starch (HES) 130/0.4 solution on the rate transfusion, laboratory parameters, and the incidence of complications as compared with those in the control group receiving no preoperative HHD. MATERIAL AND METHODS: 80 patients who had undergone total prostatectomy or cystectomy were randomized into 2 groups. Before anesthesia, the HHD group (n=40) received 15 ml/kg of 6% HES 130/0.4 solution. In the HHD and control (n=40) groups, 6% HES 130/0.4 was intraintraoperatively infused in its maximum dose of 33 ml/kg according to the patients' needs. Indicationsf or blood transfusion trigger were Hb <5 g/dl or packed cell volume < 0.24. Laboratory parameters (Hb, PCV, platelets, prothrombin index, prothrombin time, thrombin time, fibrinogen, antithrombin III were measured before surgery, after HHD and 2, 24, and 48 hours after surgery. The mean blood pressure (MBP), heart rate (HR), and central venous pressure (CVP) were determined before surgery, after HHD, and 2 hours postsurgery. Statistical measurements were made in all patients from the HHD and control groups, as well as in a subgroup, in which intraoperative blood loss was greater than 30% of the total blood volume (70 ml/kg body weight). RESULTS: Demographic data and surgical techniques were similar in both groups. After HHD, CVP rose significantly. The changes in MBP and HR were statistically insignificant. There were no complications after HHD. Of the 40 HHD-group patents, 5 needed donor blood transfusion while in the control group blood was transfused to 10 of the 40 patients in the control group. Comparing both groups showed a lower need for blood transfusion in the HHD-group patients than in the controls (10 versus 24 packed red cells). The postoperative Hb values showed no difference between both groups. CONCLUSIONS: Preoperative HHD in patients undergoing surgery with expected >30% blood loss leads to decreased needs for blood transfusion. The method is safe and easy-to-use.

Blood Loss, Surgical↗

PubMedDate not supplied

An unusual cause of acute lower gastrointestinal bleeding.

A 45 year old male patient was referred to hospital after syncope during defaecation. Rapid peranal blood loss occurred shortly after admission. Gastroscopy and coloscopy performed as first line diagnostic measures failed to detect the source of haemorrhage. Ultrasound (US) revealed a hypoechoic and hypervascularized tumor mass in the right lower abdomen. A gastrointestinal stromal tumor (GIST) of the jejunum was diagnosed after laparatomy. Collectively US should be among the first line diagnostic procedures in younger patients presenting with lower gastrointestinal haemorrhage.

Gastrointestinal Hemorrhage↗

PubMedDate not supplied

[Composition of intervillous thrombi from maternal and fetal blood].

In serological studies blood groups of intervillous thrombi of the placenta were identical with maternal blood groups in 88.9%. Identity with fetal blood groups occurred in 11.1%. Utilizing an elution technique in smears prepared from intervillous thrombi, 11.68% of the erythrocytes were of fetal, 88.32% of maternal origin. In conclusion, intervillous thrombi are mainly composed of maternal cells. The existence of small amounts of fetal cells simultaneously, points to the possible etiology: Local damage of the trophoblastic epithelium of the villi is followed by escape of fetal cells into the intervillous space and later aggregation of maternal blood. Finally, the clinical relevance of intervillous thrombosis in maternal Rh-isoimmunization, pregnancy induced hypertension and intrauterine fetal anaemia is discussed.

ABO Blood-Group System↗