[Transfusion supply optimization in multiple-discipline surgical hospital].

AIM: To define optimal variant of transfusion supply of hospital by blood components and to decrease donor blood expense via application of blood preserving technologies. MATERIAL AND METHODS: Donor blood components expense, volume of hemotransfusions and their proportion for the period 2012-2014 were analyzed. RESULTS: Number of recipients of packed red cells, fresh-frozen plasma and packed platelets reduced 18.5%, 25% and 80% respectively. Need for donor plasma decreased 35%. Expense of autologous plasma in cardiac surgery was 76% of overall volume. Preoperative plasma sampling is introduced in patients with aortic aneurysm. Number of cardiac interventions performed without donor blood is increased 7-31% depending on its complexity.

[Strategy of transfusion in cardiac and aortic surgery].

Current trend in transfusion is a decreasing of the donor's blood use due to possible complications. The article deals with analysis of intraoperative blood loss in different surgeries on the heart and aorta and of a role of blood-saving factors in decreasing of the donor's blood transfusion. We found a correlation between the blood components need and type of surgery and assessed a preoperative provision of autoplasma and intraoperative autohemotransfusion with a blood sampling from the right atrium before the beginning of artificial circulation (Complex use of the blood-saving methods with a prophylactics and treatment of hemostasis disturbances allowed the significantly decreasing of the donor's blood use. 50-70% of patients did not receive components of the donor's blood during cardiac surgery.

[Discrete plasmapheresis for coronary heart disease].

AIM: To provide a rationale for the expediency and efficiency of discrete plasmapheresis (PA) in the package of therapeutic measures for coronary heart disease (CHD). SUBJECTS AND METHODS: 585 sessions or 120 cycles of low-volume therapeutic PA were performed in 91 patients with CHD. The parameters of blood lipid composition, hemocoagulation, rheology, and endotoxicosis were studied. RESULTS: Removal of 100% circulating plasma volume per treatment cycle could achieve a significant positive result of abnormally higher homeostatic parameters. The levels of high-density lipoprotein cholesterol, antithrombin III, and albumin did not decrease significantly. CONCLUSION: Low-volume discrete PA is a pathogenetically sound and effective method to affect homeostasis in CHD.

[Clinical aspects of autologous blood donation in cardiosurgery].

The paper presents auto donation protocols and a procedure for autodonor plasmapheresis used in cardiosurgical patients, complications, and their preventive measures on the basis of an analysis of 308 autodonor plasmapheresis procedures performed at the Russian Surgery Research Center, Russian Academy of Medical Sciences, in 2007. The preoperative autoblood preservation safety concept envisaging the safety of autodonors during blood donation, the correct storage and issue of autocomponents, and the prevention of adverse reactions to blood exfusion in patients was introduced. The rate of the reactions was 6.4% of the total number of auto donations in cardiosurgical high-risk patients, moderate reaction being most common. The findings indicated that exfusion of 450 ml of blood without previous infusion of plasma substitutes was a cause of collaptoid reactions in 14 cases of the collapse-complicated procedures of autodonor plasmapheresis in cardiosurgical patients (in 70% of the total number of complications). No association was found between of the frequency and severity of complications and the nosological entity, age, and body mass index; however, a further retrospective analysis of 1500 fresh frozen autoblood preservation procedures that have recently made at the Russian Surgery Research Center, Russian Academy of Medical Sciences, is required to have statistically significant data.

[A case of successful treatment for secondary multiple organ dysfunction evolving in a patient after a combined operation replacing the mitral and aortic valves in combination with aortocoronary bypass surgery and endarterectomy from the internal and external carotid artery].

The paper describes a case of successful treatment in a patient with secondary multiple organ dysfunction (mainly hepatic and renal failure), by concurrently using different methods of efficent therapy (ultrahemodiafiltration, plasmapheresis) and infusion of the hepatic protectant heptral.

[Haemorheological impairments following aortic surgery and methods of correction thereof].

The article deals with the findings concerning alterations in rheological properties of the blood in patients who endured aortic surgery with and without artificial circulation. Also shown herein is the contribution of the plasmatic and erythrocytic components to the development of haemorheological disorders in the postoperative period. To this was added the assessment of the role plasmapheresis plays in correction of impaired blood rheological properties, depending upon the terms of its carrying out and the type of a surgical intervention performed.

[Influence of posttransplantation plasmapheresis on results of transplantation of a cadaveric kidney]. / Vliianie posttransplantatsionnogo plazmafereza na rezul'taty peresadki trupnoi pochki.

Plasmapheresis was performed with "Haemonetics" (USA), PCS-Ultralite and MCS+ devices. During one procedure 1750-3550 ml of plasma were removed. Results were evaluated by the following parameters: diuresis within 24 hours after surgery, number of hemodialysis sessions after surgery, period of normalization of creatinine in blood. In patients of the study group oligoanuria was seen 4.5 times more rarely than in the control group, they needed less sessions of hemodialysis. Level of creatinine normalized earlier in the study group. Actually survival of patients with potent transplants was higher in the study group than in the controls. It is concluded that plasmapheresis has positive influence on the course of posttransplantation period.

[Use of plasmapheresis in the treatment of drug-resistant cardiac arrhythmias]. / Ispol'zovanie plazmafereza pri lechenii narushenii ritma serdtsa, rezistentnykh k lekarstvennoi terapii.

AIM: To study the therapeutical efficiency of plasmapheresis (PA) in patients with drug-resistant cardiac arrhythmias (CA) and its mechanisms. MATERIALS AND METHODS: Discrete PA sessions were carried out in 56 patients with drug-resistant CA: paroxysmal atrial arrhythmia (AA), ventricular and supraventricular premature contractions, supraventricular tachycardia of various etiology. Biochemical blood values, coagulographic parameters, lipid peroxidation (LPO), the spectrum of nonesterified fatty acids (NEFA), the level of medium-sized molecules were determined, ECG monitoring, EchoCG, and left ventricular radioisotope computed tomography were performed before and after a PA session. RESULTS: PA was effective in 50% of cases. The duration of its effect averaged 3.0 (1.25-5.0) months. PA was more beneficial for patients with IHD, AA with normal left atrial dimensions, and hyperlipidemia. The duration of the effect was significantly higher when antiarrhythmic drug therapy was continued after PA. Due to PA, there were significant decreases in the blood concentrations of cholesterol, medium-sized molecules, malonic dialdehyde (MDA) and in the proportion of polyunsaturated NEFA. The antiarrhythmic effect was associated with the decreases in MDA and NEFA, with a tendency for a reduction in the rate of chemiluminescence. CONCLUSION: PA may be used in the treatment of drug-resistant CA. The most significant mechanism of its antiarrhythmic activity is to recover sensitivity to antiarrhythmics. The intrinsic antiarrhythmic activity may be associated with its effect on NEFA metabolism and LPO; however, its mechanisms await further studies.

[Artificial therapeutic feeding in esophageal surgery]. / Iskusstvennoe lechebnoe pitanie v khirurgii pishchevoda.

Manifestations of the protein-energy deficiency were studied in 150 patients with burn strictures of the esophagus, and the ways of their correction by means of artificial therapeutic feeding were analysed. It was shown, that inclusion of an adequate artificial nutrition diet into the preoperative medication allows for preoperative normalization of the patient's nutritional status and thus for a significant improvement of postoperative results.