[Objectives of a bloodless surgery program. A comparative study (major surgery vs. minor-medium surgery) in 51 Jehova's Witnesses patients]. / Obiettivi di un programma di chirurgia senza sangue. Studio comparativo (chirurgia maggiore vs chirurgia minore-media) su 51 pazienti testimoni di Geova.

AIM: The purpose of this retrospective review of the charts of 51 Jehovah's Witness patients, who underwent surgery without blood transfusions, was to compare two study groups (major surgery vs minor-medium surgery). METHODS: We compared the following variables: age, sex, length of stay, type of surgical operation, use of intraoperative red cell salvaging devices, hemodilution, number of drainages and their stay, postoperative blood loss, complications, need of reoperation and mortality rate. Between medical variables we focused on blood production therapy and nutritional support (administration of iron, folate, erythropoietin and albumin) and blood tests (at the first day of admission; intraoperative; at the first postoperative day; at the discharge). RESULTS: In the two study groups, we detected statistically significant differences in the following variables: total of postoperative blood loss (p < 0.00001), complications rate (p = 0.0122) and in Hgb values (intraoperative: p = 0.0197; at the first postoperative day: p = 0.0028; at the discharge: p = 0.0100). DISCUSSION: The aims of a bloodless surgery program are: 1) minimize blood loss, reducing iatrogenic anemia and intraoperative hemorrhage loss; 2) maximize blood production by administration of erythropoietin, iron and folate; 3) maximize cardiac output by alternatives to blood transfusions, as crystalloids, colloids and blood substitutes; 4) increase oxygen content; 5) decrease metabolic rate. We focused on advantages and disadvantages of the suggested procedures. Most interesting techniques are the normovolemic hemodilution and the intraoperative red cell salvaging devices, indispensable in emergency. CONCLUSIONS: A close team-work between surgeons, anesthesiologists and hematologists is determinant in a reference center that guarantees experience, organization, professionality, respect for the patients' will and, above all, low morbidity and mortality rates, as those reported by our series.

[Autologous transfusion technique application table]. / S.A.O.M.A. Scheda di applicazione ottimale delle metodiche di autotrasfusione.

The authors make a survey on the reasons leading to the application of different methods of autologous transfusion. They underline, incidentally, the important role played by the issues encountered in dealing with Jehovah's Witnesses as well as the discovery and spread of new transfusion transmitted diseases like AIDS and hepatitis C. They explain their experience, from which they have produced a Best Autologous Transfusion Technique Application Table (Scheda di Applicazione Ottimale delle Metodiche di Autotrasfusione, SAOMA), specific for every type, of operation, through the analysis of many parameters (surgeon, anaesthetist, transfusionist, general conditions of the patients, type of surgical operation). Moreover the authors evaluate advantages and disadvantages of the different autologous transfusion methods, including their cost efficiency aspects, and how they can be combined depending on the type of surgical operation. As a conclusion they attribute great importance to SAOMA to minimize homologous blood transfusion risks, even though at times the clinical aspect is made to prevail over the economic one.

[Preoperative blood storage and intraoperative blood recovery in elective treatment of abdominal aorta aneurysm]. / Predesposito e recupero intraoperatorio di sangue nel trattamento elettivo degli aneurismi dell'aorta addominale.

We evaluated the efficiency and costs-effectiveness of blood predonation and intraoperative salvage in elective abdominal aortic aneurysm surgery. Between January 1992 and January 1994, 66 patients (59 male and 7 female, aged 69.9 +/- 0.8 years) who underwent elective surgical repair of an AAA were selected for the study. Thirty-six (54.5%) patients (Group 1) intra- and/or postoperatively received homologous blood whereas 30 (45.5%) patients (Group 2) received autologous blood predonation and intraoperative blood aspiration and reinfusion. The two groups were similar for demographic data, aneurysmal diameter and associated diseases and/or risk factors (p = NS). Operative mortality was comparable between the two groups (p = NS). The mean intraoperative blood loss was 803.4 +/- 104.5 ml in group 1 and 812.8 +/- 44.8 ml in group 2 (p = NS). Group 2 patients received intra- or postoperatively a mean of 0.8 +/- 0.2 units of homologous blood (p < 0.001). Aneurysmal diameter did not influence the transfusion requirement between the two groups (p = NS). The cost per unit of homologous banked blood was significantly higher (p < 0.01). Cumulative costs of the procedures did not show statistical differences between the two groups (p = NS). Aortic surgery is the ideal target for predonation and intraoperative blood salvage.

[Evaluation of some coagulation tests in women using low dosage oral contraception]. / Valutazione di alcuni test della coagulazione in donne che usano contraccettivi orali a basso dosaggio.

PIP: This study assessed the effects of 3 types of combined oral contraceptives (OCs) on blood coagulation. The OCs investigated were a monophasic (EE 30 mcg + DOG 150 mcg), another monophasic (EE 30 mcg + LNG 150 mcg), and a triphasic (EE 30 mcg + LNG 50 mcg, EE 40 mcg + LNG 75 mcg, EE 30 mcg + LNG 125 mcg). 60 women between the ages of 19-30 with no contraindications to OC use were randomly recruited and divided into 3 groups. A blood sample was collected at a baseline level, and after 3 and 6 months of use. The parameters examined were antithrombin III, prothrombin time, partial thromboplastin time, fibrinogen degradation products, and protamina sulphate testing. There were no significant changes in any of the coagulation tests during the treatment period with these 3 different OCs. Thus, these OC compounds appear to be equally safe for use. (author's modified)^ieng