Successful Blood Conservation During Craniosynostotic Correction With Dual Therapy Using Procrit and Cell Saver

Abstract

Skin tumors comprise the largest group of malignancies of the head. Despite the accessibility of such lesions, the treatment of neglected, far advanced cancers, many of which have extended deeply into the facial bones and skull, is often required. The key to the cure of malignant tumors of the head is an accurate diagnosis and evaluation of the margins of an excised tumor. Reconstructive surgery of the head after resection of tumors requires a complete understanding of the anatomy of this region. From January 1986 to December of 2005, 31 patients underwent reconstructive surgery for nonmelanoma skin tumors involving the craniofacial region. Preoperative evaluation of the patients was performed in all cases. The results were estimated from the oncologic and functional point of view. The reconstruction, which was performed, included local, regional, and free flaps. In our series, the 5-year disease-free survival rate was 87%. The primary goal of surgical treatment of skin tumors with invasion of craniofacial bone structure is three-dimensional tumor resection with histologically clear margins. This goal has to be balanced, however, with an acceptable functional and aesthetic result. Resections are planned according to pathologic considerations rather than according to the anatomy involved.

Intra-Operative Blood Salvage in Total Hip and Knee Arthroplasty

“…THA was no longer a predictor for allogeneic blood transfusion, as this group had more percentage of patients with a preoperative haemoglobin level <120 g/dl and female gender. discussion Intra-operative blood salvage avoids problems with the storage of pre-donated autologous blood and allogeneic blood transfusion, and enables retransfusion of more efficacious oxygen-carrying red blood cells that have a higher erythrocyte viability 23 and increased preservation of 2-3 diphosphoglycerate. 24 It also removes contaminants and concentrates the re-transfusion volume.…”

Minimizing transfusion requirements for children undergoing craniosynostosis repair: the CHoR protocol

“…Krajewski and colleagues administered EPO 3 weeks, 2 weeks, and 1 week preoperatively and used Cell Saver intraoperatively; there was a marked increase in preoperative hematocrit and lower transfusion rates. 20 Fearon and Weinthal administered EPO weekly for 3 weeks preoperatively and found an increased hemoglobin level and reduced blood transfusion. 10 Meneghini et al performed acute preoperative normovolemic hemodilution in addition to administering EPO for 3 weeks before surgery and found a decreased transfusion rate.…”

“…9 As previously mentioned, Krajewski et al found significantly reduced transfusion rates with the use of EPO and Cell-Saver. 20 In our study, all but 3 infants in the protocol group and none in the control group received recycled autologous blood. The protocol group had a significantly lower transfusion rate, consistent with previous studies.…”

“…10,20,26,35 Based on these findings, we instituted a protocol that consisted of lowering the acceptable transfusion trigger level of hemoglobin, initiating EPO/iron treatment prior to surgery to increase the preoperative hemoglobin level, and utilizing an intraoperative blood recycling device such as Cell Saver or OrthoPAT (Haemonetics Corporation) to minimize the overall rate of allogenic blood transfusion at our institution.…”

Blood Conservation Strategies in Total Hip and Knee Arthroplasty

“…Peri-operative red cell salvage re-infuses fresh blood and avoids the problems with storage of red blood cells seen with autologous pre-donation and allogeneic red blood cells. This translates to more efficacious oxygen carrying red blood cells with a higher mean erythrocyte viability [27] and increased preservation of 2-3 diphosphoglycerate [28]. The technique also incorporates washing the blood loss volume.…”