Twelve autologous blood transfusions in eight cats with haemoperitoneum.

OBJECTIVES: The objectives of this study were to describe the clinical use and outcome of autologous transfusions in cats with intracavitary haemorrhage. METHODS: A retrospective descriptive study was performed. Computerised medical records of a single referral centre were searched for cats receiving an autotransfusion. Medical records were evaluated for underlying disease process, autotransfusion technique, autotransfusion volume, time period over which the autotransfusion was given, packed cell volume (PCV) pre- and post-autotransfusion, percentage rise in PCV, use of other blood products and any complications of the procedure. Survival to discharge and survival at 2 months was documented. RESULTS: Between July 2012 and March 2018 a total of 12 autotransfusions were performed in eight cats. All patients were diagnosed with haemoperitoneum. Four of the eight cats were diagnosed with abdominal neoplasia, three had postoperative haemorrhage and one had a traumatic haemoperitoneum. Three cats received more than one autotransfusion. Blood was collected using a 23 G butterfly catheter and 20 ml syringe in 7/12 collections, a 23 G needle and 20 ml syringe in 2/12 collections and directly into syringes from the open abdomen at the time of surgery in 3/12 collections. A median volume of 50 ml (range 25-80 ml) was collected and administered, meaning a median volume of 16.5 ml/kg (range 9-26 ml/kg) was administered. The autologous transfusions were given over a median of 3 h (0.25-6 h). Five cats were given another blood product alongside the autotransfusion. Median percentage PCV increase was 5% (range 1-7%). Anticoagulant was used in 5/12 autotransfusions. No clinically relevant adverse effects were reported. Six of the eight cats survived to discharge. Two month survival was 60% (3/5). CONCLUSIONS AND RELEVANCE: Autologous transfusion appears to be a safe and effective technique for stabilising cats with haemoperitoneum. This technique allows rapid and cheap provision of blood and avoids the need for an allogenic blood donor.

Autotransfusion in dogs using a 2-syringe technique.

OBJECTIVE: To describe the successful use of an autotransfusion technique utilizing 2 syringes in 4 dogs. CASE SERIES SUMMARY: All 4 dogs in this series had a hemoabdomen and subsequent hypovolemic shock. During surgery blood was collected from the abdominal cavity by the surgeon and passed to an assistant. The blood was then transferred to a second syringe for direct IV administration. The blood was passed through an inline blood filter prior to reaching the patient. Given the transfusion volume and administration time frame, 3 cases were classified as a massive transfusion. All 4 dogs survived the transfusion, were discharged within 3 days of surgery/transfusion and no complications were noted. NEW OR UNIQUE INFORMATION PROVIDED: This case series describes a relatively simple method of performing an autotransfuion in patients with hemoabdomen and hypovolemic shock.

Management of hemorrhage complicated by novel oral anticoagulants in the emergency department: case report from the northwestern emergency medicine residency.

Anticoagulation has long complicated the care of hemorrhage in the emergency department and other acute care settings. With the advent of novel anticoagulants such as direct thrombin inhibitors and direct factor Xa inhibitors, the absence of any direct antidote for these medications presents new and difficult challenges in the management of hemorrhagic complications in these patients. We present 2 cases of patients with hemorrhagic complications taking novel oral anticoagulants, their management, and outcomes.

Autologous blood transfusion following red blood cell salvage for the management of blood loss in 3 dogs with hemoperitoneum.

OBJECTIVE: To describe the use of autologous transfusion using a red blood cell salvage device for the management of large volume hemorrhage in 3 dogs with hemoperitoneum. CASE SERIES SUMMARY: Three dogs were managed for large volume hemorrhage by autologous transfusion of red blood cells after cell salvage. In all cases, blood was salvaged from the abdominal cavity during surgery. The causes of hemorrhage included testicular arterial hemorrhage after castration, hepatic parenchymal hemorrhage following hepatic dissection for intrahepatic portosystemic shunt ligation, and intra-abdominal serosal hemorrhage associated with Angiostrongylus vasorum infection. In all cases, autologous transfusion was not associated with any identified complications and contributed to improved cardiovascular stability and packed cell volume. NEW OR UNIQUE INFORMATION PROVIDED: This case series is the first to describe the use of a semiautomated red blood cell salvage system for the clinical management of acute hemorrhage in dogs. This case series provides evidence that this procedure can be used safely and effectively for the management of clinical hemorrhage. On this basis, further veterinary evaluation can be justified.

Management of patients with ectopic pregnancy with massive hemoperitoneum by laparoscopic surgery with intraoperative autologous blood transfusion.

STUDY OBJECTIVE: To evaluate the feasibility and safety of surgical laparoscopy with intraoperative autologous blood transfusion for ectopic pregnancy with massive hemoperitoneum. DESIGN: Retrospective analysis (Canadian Task Force classification II-1). SETTING: Department of gynecology at a general hospital. PATIENTS: Seventeen consecutive patients with ectopic pregnancy with massive hemoperitoneum. INTERVENTION: Laparoscopic surgery with salvage device-based intraoperative autologous blood transfusion. MEASUREMENTS AND MAIN RESULTS: From January 2000 through June 2005, one hundred and twelve women with ectopic pregnancy (interstitial/cornual: 4; isthmic: 18; ampullary: 86; and ovarian: 4) were treated by laparoscopic surgery. Seventeen patients who demonstrated more than 501 g of intraabdominal bleeding were classified as having massive hemoperitoneum and retrospectively analyzed. Site of pregnancy in these 17 patients was interstitial/cornual: 3; isthmic: 5; ampullary: 7; and ovarian: 2. Except for two women with tubal abortion of ampullary pregnancy, all other patients had rupture at the pregnancy site. During laparoscopic surgery, blood pooled in the abdominal cavity was collected by an irrigation and aspiration procedure, and sent to an autologous blood-salvage device to make concentrated red blood cell solution. Processed blood was immediately transfused back to the patient through a leukocyte reduction filter. The mean amount of estimated intraabdominal bleeding, which was calculated by the difference between the volumes of aspirated and irrigated fluids, was 1362.1 +/- 491.4 g, and the mean volume of reinfused processed blood was 680.6 +/- 209.5 g. No patient received banked blood at any time. The degree of hemoperitoneum was well correlated with the shock index calculated by dividing the heart rate by systolic blood pressure at triage (r = 0.72; 95% CI 0.37-0.89; p = .001). In all cases of massive hemoperitoneum, there was no need for laparotomic conversion, and homologous blood transfusion was avoided. CONCLUSIONS: Even in women with ectopic pregnancy with massive hemoperitoneum, laparoscopic surgery can be safely conducted by experienced laparoscopists with intraoperative autologous blood transfusion if hemodynamic stability is achieved by perioperative management.

Intraoperative autologous blood transfusion for hemoperitoneum resulting from ectopic pregnancy or ovarian bleeding during laparoscopic surgery.

OBJECTIVE: Our purpose was to evaluate the efficacy and safety of intraoperative autologous blood transfusion during laparoscopic surgery for hemoperitoneum in benign gynecologic disease. METHODS: The Cell Saver, Haemo Lite 2, an intraoperative autologous blood salvage device, was used in laparoscopic surgery on 18 patients with ectopic pregnancies or ovarian bleeding who had a large hemoperitoneum with/without severe anemia and hypovolemic shock. RESULTS: The blood loss was 1186 +/- 789 mL, and the volume of reinfused processed blood was 661 +/- 405 mL in ectopic pregnancy cases. The blood loss was 716 +/- 219 mL, and the volume of reinfused processed blood was 496 +/- 138 mL in ovarian bleeding. Laparoscopic surgery was performed and homologous blood transfusion was not required in any patient. No adverse reactions or procedural difficulties associated with the autologous blood transfusions occurred. CONCLUSIONS: Intraoperative autologous blood transfusion enabled the performance of laparoscopic surgery for large hemoperitoneum caused by ectopic pregnancies or ovarian bleeding without a homologous blood transfusion.

Hemoperitoneum in a continuous ambulatory peritoneal dialysis patient caused by a hepatocarcinoma treated with percutaneous embolization.

Hemoperitoneum is an infrequent but normally benign complication in continuous ambulatory peritoneal dialysis (CAPD) patients. It can occur at any time during peritoneal dialytic treatment. Hemoperitoneum is not associated with a specific disease and usually disappears spontaneously. In 20% of cases, however, hemoperitoneum is severe and requires specific investigation and emergency therapy. We report a case of hemoperitoneum in a 70-year-old, anti-hepatitic C virus-positive woman. After 48 months of CAPD treatment, a bloody peritoneal effluent developed, with severe anemia (hematocrit decreased from 30% to 20%). An abdominal computed tomography scan showed three hepatic lesions with signs of hepatic neoplasms; selective hepatic arteriography confirmed the diagnosis. Chemoembolization of the three lesions was performed, and hemoperitoneum disappeared within a few hours.

Autotransfusion and ectopic pregnancy: an experience from Tanzania.

Intraoperative autotransfusion was performed in 48 of 90 women with ectopic pregnancy, seen between 1990 and 1995. Autotransfusion was performed more frequently in the presence of hypovolaemic shock and more severe haemoperitoneum. The procedure appeared safe and useful. Contraindications and complications are discussed.

[Autotransfusion: its use in a case of spontaneous splenic rupture in non-Hodgkin's lymphoma]. / Autotrans: sua utilizzazione in un caso di rottura spontanea di milza in linfoma non Hodgkin.

The article refers to autotransfusion experience in a patient affected by lymphoma (not Hodgkin type), who reached surgery for haemoperitoneum caused by the spontaneous rupture of the spleen. Considering the pathology, this method brought unpredictable variations in the hemochrome thus leading to a deep reflection on the limitations of the use of autotransfusion.

[Reinfusion of blood in combined trauma of hollow abdominal organs]. / Reinfuziia krovi pri sochetannoi travme polykh organov briushnoi polosti.

The authors performed 122 blood reinfusions in patients with trauma to the chest and abdomen, in 25 of them with associated injury to the hollow abdominal organs. The mean volume of blood loss was 2225 ml, that of reinfusion--1092 ml. Nine patients died, 6 developed complications. The authors substantiate the tactics of transfusion therapy in massive hemoperitoneum in patients with associated trauma to the hollow abdominal organs.

[Possibility of intraoperative reinfusion of blood in coloproctology]. / Vozmozhnos't intraoperatsionnoi reinfuzii krovi v koloproktologii.

The possibility of conducting intraoperative reinfusion of blood in coloproctology is appraised on the basis of complex microbiological, cytological, and biochemical study of blood of patients who underwent operation for various diseases of the large intestine. It was found that blood escaping into the abdominal cavity during operations on the large intestine is hemolized to a great measure and contains many bacteria, and therefore such blood cannot be used for transfusion. At the same time, if blood is collected directly from the pulsating vessel its contamination, marked distortions of its formed elements, and hemolysis above admissible values can be avoided. The dependence on the time of blood collection, whether before or after the intestine is opened, has not been established.

Autotransfusion in gynecologic hemoperitoneum.

The loss of blood associated with acute hemoperitoneum accounts for a significant portion of the mortality in gynecologic practice. This report proposes the salvage of intraperitoneal blood for autotransfusion by a device developed for use in open heart operations. Two cases are presented which exemplify the indications for and limitations of autologous transfusion from hemoperitoneum.

[Autotransfusion in experimental hemoperitoneum. Hematologic study]. / Autotransfusion dans l'hémopéritoine expérimental. Etude hématologique

In order to study the hematologic repercussions of pre-operative autotransfusion, ruptures were made in experimental spleens followed by retransfusion after intraperitoneal barbotage of long duration in 8 dogs. This was performed without any heparinization. The following facts could be established:--although the blood shed was rich in red globules, it presented major alterations with a loss of clotting agents and evidence of fibrinogenic degradating elements.--A study of the blood during the transfusion and after the intervention did not reveal any intravascular coagulation but only a loss of fibrinogen and thrombocytes proportional to the amount of autotransfused blood. The limit of haemostatic tolerance with no supply of external blood was an autotransfusion ranging about 75 p. 100 of the initial blood volume.

[Autotransfusion in acute hemoperitoneum]. / L'autotransfusion des hémopéritoines aigus

This procedure is well known, there were 2 000 cases reported in the literature with a very small number of complications. Is autotransfusion really efficacious? According to the author's results in 9 cases of hemoperitoneum, the red cells obtained by this method are quantitatively valid, but hemolysis starts early (6 hours) and the disappearance of the platelets and coagulation factors occurs even more early (2 hours). However, clinical tolerance is perfect, thus confirming the good experimental results obtained in animals. The true limits are hemolysis and the risk of contamination but, with appropriate apparatus and precise indications, and unsoiled blood, less than 24 hours old, autotransfusion is a good method which may provide a solution in certain emergencies.

Autotransfusion in ruptured ectopic pregnancy

In a fourteen year period 1055 cases of ruptured ectopic pregnancy were operated on at one hospital in the West Indes. 76 percent of these patients required transfusion, and 530 were given their own blood collected from the intraperitoneal cavity, with or without donor blood. In 424 other cases the blood collected in this way was unsuitable for autotransfusion. On blood culture only "air contaminants" were found. There were only two complications (fever in one case and hypotension in another) and no deaths related to transfusion. In view of the hazards of transfusion of donor blood and the shortage of such blood in many centres, a plea is made for the reintroduction of this procedure in the management of ruptured ectopic pregnancies (AU)