Nine treatments of 1000 mL therapeutic phlebotomy in a subject with polycythemia: A case report.

Large-volume therapeutic phlebotomy is the mainstay of hemochromatosis treatment and offers an opportunity to investigate the hemodynamic changes during acute hypovolemia. An otherwise healthy 64-year-old male with hemochromatosis participated. On nine separate visits, 1000 mL therapeutic phlebotomy was performed. On one occasion, pre- and post-phlebotomy orthostatic challenge with 27° reverse Trendelenburg position was administered. Mean arterial pressure, heart rate, and stroke volume were measured continuously during the procedures. The patient's tolerance to the interventions was continuously evaluated. The procedures were well tolerated by the patient. Mean arterial pressure was maintained during hemorrhage and following phlebotomy in both supine and reverse Trendelenburg positions, primarily through an increase in heart rate and systemic vascular resistance. The present study found that 1000 mL therapeutic phlebotomy in a patient with hemochromatosis may be acceptably and safely used to model hemorrhage. The approach demonstrates high clinical applicability and ethically robustness in comparison with volunteer studies.

Abstracts from The Cold Weather Operations Conference 2021.

A common effort for both military and civil healthcare is to achieve knowledge-based health care in cold weather injuries and fatal accidents in harsh arctic environment. The Cold Weather Operations Conference in November 2021, having more than 300 participants from 20 countries, was addressing the prevention and treatment of injuries and trauma care in cold weather conditions and the challenges for military prehospital casualty care. The intention of the programme was to stimulate further research and systematic knowledge-based clinical work. The abstracts from the conference present cold weather research and clinical experience relevant for readers of the International Journal of Circumpolar Health.

Cardiac stroke volume variability measured non-invasively by three methods for detection of central hypovolemia in healthy humans.

PURPOSE: Hypovolemia decreases preload and cardiac stroke volume. Cardiac stroke volume (SV) and its variability (cardiac stroke volume variability, SVV) have been proposed as clinical tools for detection of acute hemorrhage. We compared three non-invasive SV measurements and investigated if respiration-induced fluctuations in SV may detect mild and moderate hypovolemia in spontaneously breathing humans. METHODS: Ten healthy subjects underwent experimental central hypovolemia induced by lower body negative pressure to -60 mmHg or onset of presyncopal symptoms. SV beat-to-beat was estimated simultaneously by ultrasound Doppler, finger arterial blood pressure curve and impedance cardiography. SVV was calculated by spectral analysis between 0.15 and 0.40 Hz. RESULTS: Relative changes in SV did not show significant differences between the methods. The SVV measured by ultrasound Doppler and arterial blood pressure curve decreased at -30 mmHg to 32 % (ultrasound Doppler: 95 % CI 18-47, arterial blood pressure curve: 95 % CI 21-43) and at maximal simulated hypovolemia to 23 % (ultrasound Doppler: 95 % CI 14-81) and 21 % (arterial blood pressure curve: 95 % CI 9-33) of baseline variability. The variability in cardiac stroke volume from the impedance cardiography did not change significantly during the simulated hypovolemia, to 88 and 76 % of baseline variability. CONCLUSION: Cardiac stroke volume estimated by ultrasound Doppler and by arterial blood pressure curve showed parallel variations beat-to-beat during simulated hemorrhage, whereas impedance cardiography did not appear to track beat-to-beat changes in cardiac stroke volume. The variability in cardiac stroke volume was decreased during mild and moderate hypovolemia and could be used for early detection of hypovolemia.

Symposium on fresh whole blood for severe hemorrhagic shock: from in-hospital to far forward resuscitations.

This report is prepared for The Hemostasis and Oxygenation Research (THOR) Network and based on presentations of invited THOR investigators. In order to make it available to a larger group of interested readers it has been agreed to publish the report in TRASCI, as a "what is happening?" in view of its importance and novelty. On June 14th 2011 the first symposium on fresh whole blood (FWB) was held in Bergen, Norway. THOR network leadership, which includes Tor Hervig, PhD, MD, Geir Strandenes, MD, Erling Bekkestad Rein, MD, and Philip C. Spinella, MD, organized the event. It was sponsored by the Royal Norwegian Navy Medical Service, Norwegian Armed Forces Medical Services and Caridian BCT. The objective of this meeting was to bring together investigators from around the world who are interested in analyzing the efficacy and safety of FWB for patients with severe traumatic hemorrhagic shock and to determine the initial steps in developing a research program in this area. The THOR network is specifically interested in determining if FWB can improve morbidity and mortality in combat casualties with life threatening hemorrhagic shock. A three-year research proposal has been developed by the THOR network to determine (1) if FWB donation adversely affects donor performance of combat related skills, (2) the optimal storage solution, temperature, and acceptable storage duration for FWB, (3) the logistics of providing FWB in a combat environment safely to include optimal transport and administration methods. The symposium speakers were tasked with reviewing current data on; coagulopathy associated with massive traumatic bleeding, immunology of transfusion, outcomes associated with FWB use, logistic and medical issues of the use of FWB in far forward situations, training required for medics on FWB collection and administration, the risks of FWB and stored blood components and methods to mitigate these risks. The meeting concluded with a discussion of the THOR network's three-year research program.