Raymond A. Dieter

Preoperative coagulation profiles and posthemodilution cardiopulmonary bypass hemorrhage

Abstract Thirty-one patients had coagulation studies prior to total cardiopulmonary bypass utilizing hemodilution with Ringers lactate solution. Preoperative screening for bleeding tendencies is a prerequisite to major surgery. No patient in the present study indicated a history of bleeding difficulties. However, there was an average of 3.3 abnormal bleeding and coagulation values in each of these thirty-one patients prior to surgery. The degree of disturbance of blood coagulation and fibrinolytic activity varied considerably from patient to patient. No correlation was available to predict which patient would have massive hemorrhage after cardiopulmonary bypass. The preoperative laboratory studies appeared to be beneficial in determining the treatment of immediate postoperative hemorrhage. However, if persistent serious bleeding occurs postoperatively, then the coagulation profile should be repeated. These patients received an average of six units of blood per operation. Four patients received no blood transfusions. The remaining twenty-seven patients required one to thirty transfusions. Good surgical hemostasis and adequate protamine neutralization are believed to be of prime consideration. Short pump runs and small volume hemodilution were correlated with the smallest number of transfusions. Preoperative anticoagulant therapy appeared to have no effect on the postsurgical blood requirement.

Tracheal Resection and Pregnancy

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