Strategies to avoid empiric blood product administration in liver transplant surgery

Abstract

Massive blood loss has been a dreaded complication of liver transplantation, and the accompanying transfusion is associated with adverse outcomes in the form of decreased patient and graft survival. With advances in both surgical techniques and anesthetic management during transplantation, blood and blood products requirements reduced significantly. However, transfusion practices vary among different centers. The altered coagulation parameters in patients with liver cirrhosis results in a state of “rebalanced hemostasis” and patients are just as likely to clot as they are to bleed. Commonly used coagulation tests do not always reflect this new state and can, therefore, be misleading. Transfusion of blood products solely to correct abnormal parameters may worsen the coagulation status, thus adversely affecting patient outcome. Point-of-care tests such as thromboelastometry more reliably predict the risk of bleeding in these patients and in addition may provide quicker turnaround times compared to routine tests. Perioperative management should also include the possibility of thrombosis in these patients, and the use of low-molecular-weight heparin correlates with better patient survival. This review article aims to highlight the concept of rebalanced hemostasis, limitation of routine coagulation tests, and harmful effect of empiric transfusion of blood products.

A comprehensive review of the classification of fibromyalgia, its possible genetic and environmental causes, and its epidemiology in Pakistan

“…A study suggest that fibromyalgia may develop spontaneously [4], but it is more likely to be a stereotypical, maladaptive biological reaction to the combined impacts of physical and mental stress in genetically predisposed individuals [5]. It is associated with psychological and physical issues, which might result in diminished outcomes [6]. However, it can also develop following an infection.…”