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Strategies to reduce perioperative blood loss related to non-surgical bleeding

Published online by Cambridge University Press:  11 July 2005

A. Menzebach ,
U. Cassens ,
H. Van Aken  and
M. Booke
A. Menzebach
Affiliation:
University Hospital Muenster, Department of Anaesthesiology and Intensive Care, Muenster, Germany
U. Cassens
Affiliation:
University Hospital Muenster, Department of Transfusion Medicine, Muenster, Germany
H. Van Aken
Affiliation:
University Hospital Muenster, Department of Anaesthesiology and Intensive Care, Muenster, Germany
M. Booke
Affiliation:
MTK-Kliniken, Department of Anaesthesiology, Bad Soden, Germany
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Summary

The treatment of critically ill patients has advanced markedly over the last decade. However, non-surgical bleeding of a diffuse nature from numerous tiny capillaries still remains a challenge. Once initiated, this type of bleeding may be troublesome and a vicious circle develops since it is not a single vessel contributing to this blood loss. The description ‘non-surgical blood loss’ is often given to this. This review describes a step-by-step approach for the treatment of non-surgical bleeding and includes various measures, such as desmopressin, blood components, antifibrinolytics, antithrombin III, prothrombin complex concentrates and factor XIII. While most non-surgical bleedings can be managed using the approach described here, a number of patients still continue to bleed. In these cases, the surgeon should re-evaluate the bleeding in terms of its surgical origin. If this can positively be excluded and if all of measures described fail to reduce or stop the bleeding, further treatment of such uncontrolled bleeding remains symptomatic.

Keywords

BLOOD COAGULATION FACTORS, factor XIIIBLOOD TRANSFUSION, blood component transfusionCRITICAL CARE, intensive careENZYME INHIBITORS, protease inhibitors, serine proteinase inhibitors, antithrombin IIIHAEMORRHAGE, blood loss, surgicalHAEMOSTASIS, blood coagulationHAEMOSTATICS, antifibrinolytic agentsPITUITARY HORMONES, POSTERIOR, vasopressins, desmopressin
Type
Review
Information
European Journal of Anaesthesiology , Volume 20 , Issue 10 , November 2003 , pp. 764 - 770
Copyright
© 2003 European Society of Anaesthesiology

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