Therapy of acute massive blood loss in a hemophiliac male: case report

Abstract

A case is reported of management of massive intraoperative blood loss in a male patient with severe hemophilia. Extirpation of hip pseudotumor with one-stage osteosynthesis with an intramedullary joint-pin in a 43 year old male patient was accompanied with 7.5 l blood loss. The infusion-transfusion therapy (ITT) contained transfusion media about 1/3 of the total volume, fresh-frozen plasma and erythrocyte-containing media were used 1:1. Infusion solutions consisted of balanced polyelectrolytic solutions, hydroxyethylated starches 130/0.4, hyperchaes. Intraoperative normovolemic hemodilution and reinfusion of wound blood were made (CellSaver). ITT target markers were standard hemodynamics control tests. Hemostasis monitoring was conducted with thromboelastography. Complex ITT based on modern principles of clinical transfusiology provided a complete and safe compensation of massive intraoperative blood loss in a patient with severe hemophilia.

About the authors

Andrey Yul'evich Bulanov

Email: buldoc68@mail.ru

Elena Markovna Shulutko

Evgeniy Evgen'evich Karpov

Email: karpov.evg@mail.ru

Tat'yana Yur'evna Polyanskaya

Email: polyantat@rambler.ru

Georgiy Vladimirovich Mishin

Sergey Aleksandrovich Morozov

Email: sergeymorozov.hrc@gmail.com

Nikolay Nikolaevich Kalinin

Aleksandr Vladimirovich Tochenov

Konstantin Vladimirovich Yatskov

Vladimir Yur'evich Zorenko

Magomed Sultanovich Sampiev

A Yu Bulanov

Hematological Research Center, Moscow

Hematological Research Center, Moscow

E M Shulutko

Hematological Research Center, Moscow

Hematological Research Center, Moscow

E E Karpov

Hematological Research Center, Moscow

Hematological Research Center, Moscow

T Yu Polyanskaya

Hematological Research Center, Moscow

Hematological Research Center, Moscow

G V Mishin

Hematological Research Center, Moscow

Hematological Research Center, Moscow

S A Morozov

Hematological Research Center, Moscow

Hematological Research Center, Moscow

N N Kalinin

Hematological Research Center, Moscow

Hematological Research Center, Moscow

A V Tochenov

Hematological Research Center, Moscow

Hematological Research Center, Moscow

K V Yatskov

Hematological Research Center, Moscow

Hematological Research Center, Moscow

V Yu Zorenko

Hematological Research Center, Moscow

Hematological Research Center, Moscow

M S Sampiev

Hematological Research Center, Moscow

Hematological Research Center, Moscow

References

  1. Kashuk J. L., Moore E. E., Johnson J. L. et al. Postinjury life threatening coagulopathy: is 1:1 fresh frozen plasma: packed red blood cells the answer? J. Trauma 2008 65 (2): 261-270.
  2. Duchesne J. C., Hunt J. P., Wahl G. Review of current blood transfusions strategies in a mature level I trauma center: were we wrong for the last 60 years? J. Trauma 2008; 65: 272-276.
  3. Dente C. J., Shaz B. H., Nicholas J. M. et al. Improvements in early mortality and coagulopathy are sustained better in patients with blunt trauma after institution of a massive transfusion protocol in a civilian level I trauma center. J. Trauma 2009; 66: 1616-1624.
  4. Shaz B. H., Dente C. J., Harris R. S. et al. Transfusion management of trauma patients. Anesth. Analg. 2009; 108: 1760- 1768.
  5. Leal S. R., Munoz M., Paramo J. A., Garcia-Erce J. A. Spanish consensus statement on alternatives to allogenic blood transfusion: the "Seville document" Transfusion Alternatives in Transfusion Medicine 2006; 8: 178-202.
  6. Горобец Е. С. Принципы инфузионно-трансфузионной терапии при массивной операционной кровопотере. Соврем. онкол. 2005; 7: 202-208.
  7. Морозов С. А., Петров М. М., Варламова С. В. и др. Алгоритм заготовки компонентов аутокрови у больных гемофилией. В кн.: Материалы научно-практической конференции "Актуальные вопросы гематологии и трансфузиологии". 8 июля 2009 г. Санкт-Петербург: 71-72.
  8. Scheingraber S., Rehm M., Sehmisch C., Finsterer U. Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology 1999; 90: 1265- 1270.
  9. Boldt J., Suttner S., Brosch C. The influence of a balanced volume replacement concept on inflammation, endothelial activation, and kidney integrity in elderly cardiac surgery patients. Intensive Care Med. 2009; 35: 462-470.
  10. Langeron O., Doelberg M., Ang E.-T. et al. Voluven, a lower substituted novel hydroxyethyl starch (HES 130/0,4), causes fewer effects on coagulation in major orthopedic surgery than HES 200/0,5. Anesth. Analg. 2001; 92. 855-862.
  11. Буланов А. Ю., Городецкий В. М., Шулутко Е. М. и др. Влияние различных типов коллоидных объемозамещающих растворов на измененную систему гемостаза. Анестезиол. и реаниматол. 2004; 2: 25-29.
  12. Бутров А. В., Галенко С. В. Комбинированные гипертонические растворы в интенсивной терапии. Новости анестезиол. и реаниматол. 2007; 1: 57-60.
  13. Bundgaard-Nielsen M., Secher N. H., Kehlet H. "Liberal" vs. "restrictive" perioperative fluid therapy - a critical assessment of the evidence. Acta Anaesthesiol. Scand. 2009; 53: 843-851.
  14. Johansson P. I., Ostrowski S. R., Secher N. H. Management of major blood loss: an update. Acta Anaesthesiol. Scand. 2010; 54: 1039-1049.
  15. Щербакова О. В., Буланов А. Ю., Шулутко Е. М. и др. Метод дифференциальной экспресс-диагностики периоперационных кровотечений. Вестн. Рос. ун-та дружбы народов 2005; 31(3): 84-88.

Statistics

Views

Abstract: 127

Article Metrics

Metrics Loading ...

Refbacks

  • There are currently no refbacks.

Copyright (c) 2020 Bulanov A.Y., Shulutko E.M., Karpov E.E., Polyanskaya T.Y., Mishin G.V., Morozov S.A., Kalinin N.N., Tochenov A.V., Yatskov K.V., Zorenko V.Y., Sampiev M.S., Bulanov A.Y., Shulutko E.M., Karpov E.E., Polyanskaya T.Y., Mishin G.V., Morozov S.A., Kalinin N.N., Tochenov A.V., Yatskov K.V., Zorenko V.Y., Sampiev M.S.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Novoslobodskaya str 31c4., Moscow, 127005, Russian Federation

Managing Editor:

 

© 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies