Bar Graphs & Blood Banks…

“Red cell transfusion rates for CPB patients are the highest and most variable amongst all surgical patients.” Editor’s Note: This discussion comes up so often, it borders on the ridiculous- because there has never really been any closure or academic consensus regarding transfusion thresholds- and the point at which we decide we are “going to […]

EBOLA: Protective Gear: How to AVOID Contamination

Click image to view article Editor’s Note: As healthcare professionals, even though we are unlikely to come into direct contact with ebola patients, it is nevertheless incumbent upon us to at least be slightly prepared. Our environmental awareness regarding our surroundings and contamination issues (sterile technique etc-), is much more refined than most other specialties in […]

EBOLA: Facts NOT Myths – A brief primer for all of us

Click image to view article Editor’s Note: As healthcare professionals, even though we are unlikely to come into direct contact with ebola patients, it is nevertheless incumbent upon us to at least be slightly prepared. Our environmental awareness regarding our surroundings and contamination issues (sterile technique etc-), is much more refined than most other specialties in […]

EBOLA: For Ebola caregivers, enormous fear, risk and bravery

  Click image to view article Editor’s Note: As healthcare professionals, even though we are unlikely to come into direct contact with ebola patients, it is nevertheless incumbent upon us to at least be slightly prepared. Our environmental awareness regarding our surroundings and contamination issues (sterile technique etc-), is much more refined than most other specialties […]

EBOLA: Our environmental awareness regarding our surroundings

Click image to view article Editor’s Note: As healthcare professionals, even though we are unlikely to come into direct contact with ebola patients, it is nevertheless incumbent upon us to at least be slightly prepared. Our environmental awareness regarding our surroundings and contamination issues (sterile technique etc-), is much more refined than most other specialties in […]

The TEG (Thromboelastogram)

Editor’s Note: Recently we began employing the TEG routinely for all of our open-heart procedures.  Now I am relatively familiar with the concept, having discussed and written about it before.  However there is an array of numbers and categories that come with the TEG analysis that I wasn’t certain about, so to clear it up […]

Looking for Protocols… The Potential Benefits of del Nido Cardioplegia

Editor’s Note: I got a message quite awhile ago regarding del Nido cardioplegia.  I posted it a year or so ago- but saw a great post regarding this on Perflist, and contacted Jorge Molina, CCP for his opinion… Frank, “I wanted to post a question on your site asking if anyone has experience, protocols or […]

Cardiac Team Performance: Are You As Good As You Think You Are?

“I have taken a 14+ page form and reduced it to it’s 1 page bare essentials…” (Click Image to View STS Website) Editor’s Note: I had an interesting discussion with one of our cardiac anesthesiologists the other day. We were talking about our cardiac program’s outcomes, and the fact that I felt our program needed […]

AT3 Deficiency

Antithrombin III (AT III) is a plasma glycoprotein with a molecular weight of 58,000 daltons.  AT III deficiency may be noticed when the patient’s activated clotting time (ACT) does not respond to heparin administration as would be expected when given a standard dosage.  Also can be confirmed by a laboratory value of the patient’s AT […]

Cold Agglutinins

Literature: Click image to view source article Cold Agglutinins in Cardiac Surgery: Management of Myocardial Protection and Cardiopulmonary Bypass CAs are autoantibodies to RBC antigens [3], which can causesystemic thrombosis and hemolysis. The cause of these CAs maybe primary/idiopathic, or more commonly, secondary to an infectiveprocess (eg, mycoplasma, human immunodeficiency virus) or alymphoproliferative disorder [2]. […]

The A1C : “Say Hello To My Little Friend…”

Glycosylated Hemoglobin Called also hemoglobin A1c. Hemoglobin A with a glucose moiety attached to the amino terminal valine of the beta chain. This type of hemoglobin is made at a slow constant rate during the life span of the erythrocyte. Increased levels correlate with glucose intolerance in diabetes. With adequate insulin treatment, levels return to […]

Sickle Cell Anemia & CPB

I.    DESCRIPTION: Sickle Cell hemoglobinopathy is a single gene recessive disorder that involves an abnormality of the hemoglobin (Hgb) molecule.  This disorder causes the red cell to sickle under certain circumstances.  A sickled cell cannot undergo normal respiratory functions and they interfere with normal blood circulation. Sickle cell disease is genetic and a patient may […]

Jehovah’s Witness & Open Heart Bypass

Jehova’s Winesses:  A Background Jehovah’s Witnesses believe that the Bible prohibits ingesting blood and that Christians should therefore not accept blood transfusions or donate or store their own blood for transfusion.[1] Watch Tower Society publications teach that the Witnesses’ refusal of transfusions of whole blood or its four primary components—red cells, white cells, platelets and […]

Coagulation Issues: Fibrinolysis & HIT: Helpful Graphics

Fibrinolysis Fibrinolysis is the dissolution of the clot formation process involving the plasma protein plasminogen.  This system of enzymes dissolves blood clots by the lysis of fibrin.  Fibrinolysis plays a role as well in other biological processes such as tissue repair, macrophage activation and function, ovulation, and embryo implantation.  Fibrinolysis is mediated by plasmin and […]

Hemostasis Assays

Tests Available Screening Tests:     Prothrombin Time (PT)     activated Partial Thromboplastin Time (aPTT)     Thrombin Clotting Time (TCT)     Kaolin Clotting Time (KCT) Assessment of the Fibrinolytic Pathway:     Alpha-2-antiplasmin – functional assay     Euglobulin Lysis Time     Fibrinogen/fibrin degradation products (FDP)     Plasmin alpha-2-antiplasmin complex (PAP)     Plasminogen Activator Inhibitor – antigen (PAI-1) […]

Coagulation Cascade

Intrinsic Pathway The coagulation cascade is initiated when blood becomes traumatized by exposure to a foreign surface.  An example of this is the initiation of cardiopulmonary bypass.  Blood contact with the polyvinyl chloride tubing utilized in the extracorporeal circuit, the squeezing mechanism of the roller head pump, and various applications of blood filtering devices, all […]

Refining Extracorporeal Support Strategy: Oxygen Pressure Field Theory IX

OPFT Part IX:   Using OPFT to Refine Extracorporeal Support Strategy. The anion gap is the difference in the measured cations and the measured anions in serum, plasma, or urine. The magnitude of this difference (i.e. “gap”) in the serum is often calculated in medicine when attempting to identify the cause of metabolic acidosis. If the […]

Interpretation of the Anion Gap: Oxygen Pressure Field Theory VIII

OPFT Part VIII:  Interpreting the Anion Gap The anion gap is the difference in the measured cations and the measured anions in serum, plasma, or urine. The magnitude of this difference (i.e. “gap”) in the serum is often calculated in medicine when attempting to identify the cause of metabolic acidosis. If the gap is greater […]

The Anion Gap: Oxygen Pressure Field Theory VII

OPFT Part VII:  The Anion Gap The anion gap is the difference in the measured cations and the measured anions in serum, plasma, or urine. The magnitude of this difference (i.e. “gap”) in the serum is often calculated in medicine when attempting to identify the cause of metabolic acidosis. If the gap is greater than […]

Microvascular Redistribution: Oxygen Pressure Field Theory VI

Part VI:  Microvascular  Redistribution (Click Image to View Online Power Point Presentation) Authored by:  Gary Grist,  BS, RN, CCP, LCP    To View all of Gary Grist”s Posts Regarding OPFT-  click here Mr Gary Grist delivered a seminar on this topic at The Missouri Perfusion Society 16th Annual Meeting titled “Beyond The Fick Equation”  on June […]

The Role of Carbon Dioxide: Oxygen Pressure Field Theory V

Part V:  The Role of Carbon Dioxide Which of these unlikely bypass candidates- ” Ain’t Gonna Make It? “ Authored by:  Gary Grist,  BS,  CCP, LCP    To View all of Gary Grist”s Posts Regarding OPFT-  click here Carbon Dioxide Pressure Field Theory The term Oxygen Pressure Field Theory is a misnomer if the perfusionist is […]

Axial Gradients: Oxygen Pressure Field Theory IV

Part IV:  Axial Gradients Authored by:  Gary Grist,  BS, RN, CCP, LCP    To View all of Gary Grist”s Posts Regarding OPFT-  click here Axial Gradients To review, Oxygen Pressure Field theory states that there is an oxygen pressure field established in the tissues around each capillary where oxygen is present in varying concentrations from as […]

Blood Components

Separating Components from Whole Blood Fibrinogen Fibrinogen is a high molecular weight protein occurring in the plasma in quantities of 100 to 700 mg/dl.  In the presence of calcium ions it becomes the precursor for fibrin threads the foundation of the blood clot.  In terms of replacement therapy, a target value of 150 mg/dl may […]

Methemoglobin (METHB)

I.    DESCRIPTION: Methemoglobin (METHB) is a condition by which oxygen molecules cannot bind to hemoglobin thus the patient presents with a distinct cyanosis.  The cyanosis occurs due to an  altered hemoglobin ion from the reduced form to the oxidized ferric molecule.  This molecule is not capable of binding to or releasing oxygen. The  distinct cyanosis […]

Fetal-Hemoglobin (HbF)

“The left shift of the oxyhemoblobin dissociation curve in the presence of significant quantities of HbF indicates that there is a propensity for low delivery of oxygen to tissues.” I.    DESCRIPTION: Fetal-hemoglobin (HbF) is an abnormal hemoglobin which is characterized by the presence of 2 alpha and 2 gamma chains in its structural configuration.  HbF […]

Heparin Alternatives [Reprint]

Authored by Steve Sutton, LP, CCP Editor’s Note: Steve Sutton is well known and highly regarded into today’s Perfusion community.  He is a strong proponent for advancing Perfusion education and in pursuing that goal,  he has given numerous presentations at some of the most  premier Perfusion meetings held each year. Along with his dedication to […]

Looking for Protocols… The Potential Benefits of del Nido Cardioplegia :

Frank, “I wanted to post a question on your site asking if anyone has experience, protocols or literature supporting the use of Del Nido cardioplegia in adults.  Love the site, great first year.“ Thank you. Patrick Grady Hi Patrick, I’m not the guy with the answers, but I am sure there are a lot of […]

A Day In The Life… [3] Reprint

24 Hours… of ECMO To view the entire “Day In The Life” series Click Here Part III:  Getting Past Midnight :   ACT’s & Clots … 11:00 pm Somehow during the initial debriefing from the previous ECMO coordinator that I had taken over for, the question of reliability regarding our ACT  (Activated Clotting Time) came […]

HELP ! Lupus Anticoagulant & Measuring Heparinization for CPB

– We are anticipating placing a patient on CPB for an AVR. The patient has tested positive for Lupus Anticoagulant, so I looked up some things to assist in preparing for the case. From what I have read, it seems the following points are salient regarding proper anticoagulant management during bypass. ptt is going to […]

Hemostasis Assays

Tests Available Screening Tests:     Prothrombin Time (PT)     activated Partial Thromboplastin Time (aPTT)     Thrombin Clotting Time (TCT)     Kaolin Clotting Time (KCT) Assessment of the Fibrinolytic Pathway:     Alpha-2-antiplasmin – functional assay     Euglobulin Lysis Time     Fibrinogen/fibrin degradation products (FDP)     Plasmin alpha-2-antiplasmin complex (PAP)     Plasminogen Activator Inhibitor – antigen (PAI-1) […]

Sickle Cell Anemia v1

SICKLE CELL ANEMIA I.    DESCRIPTION: Sickle Cell hemoglobinopathy is a single gene recessive disorder that involves an abnormality of the hemoglobin (Hgb) molecule.  This disorder causes the red cell to sickle under certain circumstances.  A sickled cell cannot undergo normal respiratory functions and they interfere with normal blood circulation. Sickle cell disease is genetic and […]

Colloid v. Crystalloid ?

Selecting  Your Perfusate Authored By:  Gerard J Myers Did you ever consider why we use one type of perfusate over the other?  Thousands of cases are done with crystalloids only and thousands are done with colloid/crystalloid primes. Each program has equal results and I would imagine each program would argue that there outcome stats are […]

ABTC Conference: Live Blog

Live Blogging The Autologous Blood Therapy Course (ABTC): (Click on Image to visit ABTC website) Heading down to Jackson, Mississippi… I’ve heard some great things about this course being offered up by Mr.Pat H. Courtney, Jr. LP, RABT (Licensed Perfusionist, Registered Autologous Blood Therapist.) . First of all, Pat’s a nice guy (as well as […]

HeartMate & HIT

HeartMate XVE :  Explantation in the Setting of Heparin Induced Thrombocytopenia (HIT) Utilizing ACT and TEG Analysis Authored by:   Scott M. Noesges LP, CCP  BAYLOR UNIVERSITY MEDICAL CENTER  DALLAS, TEXAS Scott M. Noesges LP, CCP, offers the community an amazing case study of a case already highly complex in nature, complicated even more so by […]

Rx for Hemolytic Reaction

Rx  FOR HEMOLYTIC REACTION As a result of gross exposure to a hypotonic environment. Hemolysis of blood samples. Red blood cells without (left and middle) and with (right) hemolysis. If as little as 0.5% of the red blood cells are hemolyzed, the released hemoglobin will cause the serum or plasma to appear pale red or […]

Heparin Alternatives

Authored by Steve Sutton, LP, CCP Steve Sutton is well known and highly regarded into today’s Perfusion community.  He is a strong proponent for advancing Perfusion education and in pursuing that goal,  he has given numerous presentations at some of the most  premier Perfusion meetings held each year. Along with his dedication to Perfusion as […]

ERYTHROBLASTOSIS FETALIS

Erythroblastosis Fetalis (Written with assistance from Thomas Doyle, MS, CCP) I.    GENERAL INFORMATION: Erythroblastosis Fetalis is a process relating to a blood incompatibility disorder.  This disorder is characterized  by  the mother rejecting the fetus  due to an incompatibility of blood group types caused by previous pregnancy or blood transfusions.  Gamma globulin’s are transported across the […]

Protamine v1

Protamine   A polycationic protein derived from salmon milt, possess strong alkalinity because of an amino acid composition consisting of 67% arginine.  In its natural state, the numerous positive charges on the protamine molecule bind with the negatively charged phosphate groups of the nucleoprotein material of salmon sperm.  Heparin, a polyanion, binds ionically to protamine […]

AT3 Deficiency v.1

Antithrombin III (AT III) is a plasma glycoprotein with a molecular weight of 58,000 daltons.  AT III deficiency may be noticed when the patient’s activated clotting time (ACT) does not respond to heparin administration as would be expected when given a standard dosage.  Also can be confirmed by a laboratory value of the patient’s AT […]

Cold Agglutinins v.1

I.    BACKGROUND: Hypothermic cardiopulmonary bypass with the use of cold blood cardioplegia carries with it the risk of red cell agglutination caused by unsuspected cold agglutinin disease.  Patients with this condition possess serum antibodies which become reactive at temperatures usually less than 30°C and are directed against an antigen of the human erythrocyte causing agglutination […]

HIT

Heparin Induced Thrombocytopenia I.    DESCRIPTION: Heparin induced thrombocytopenia (HIT) and heparin induced thrombocytopenia thrombosis syndrome (HITTS) are immune mediated complications of heparin therapy.  An antibody, produced by the body upon initial exposure to     heparin, reacts with an antigen upon re-exposure or continuous exposure to heparin. HIT is characterized by a dramatic decrease in platelet […]

Malignant Hyperthermia v 1

I.    PATHOPHYSIOLOGY: Malignant hyperthermia (MH) is a pharmacogenetic disorder characterized by a fulminant hypermetabolic reaction of skeletal muscle induced by volatile inhalational anesthetics, succinylcholine, and possibly stress and exercise.  Until the advent of dantrolene, the mortality rate was 65% but since the introduction of dantrolene in 1979, it has decreased to between 1 and 10%. […]

Jehovah’s Witness v.1

JEHOVAH’S WITNESSES Jehovah’s Witness patients are at increased risk for morbidity and mortality associated with blood loss due to their refusal, on religious grounds, of both homologous blood transfusion and autologous blood that has been removed from  continuity with the body.  They believe that it is wrong to accept or receive any type of blood […]

Fibrinolysisv.1.0

Fibrinolysis Fibrinolysis is the dissolution of the clot formation process involving the plasma protein plasminogen.  This system of enzymes dissolves blood clots by the lysis of fibrin.  Fibrinolysis plays a role as well in other biological processes such as tissue repair, macrophage activation and function, ovulation, and embryo implantation.  Fibrinolysis is mediated by plasmin and […]

Hemostasis Assays [v.1]

Partial Thromboplastin Time (Activated) The activated partial thromboplastin time (aPTT) is test that overlaps the prothrombin time (both evaluate the common pathway), and is designed to isolate the intrinsic pathway.  While these tests are similar, the aPTT utilizes kaolin or cellite and cephaloplastin to stimulate the intrinsic pathway.  This pathway is the longer of the […]

Activated Clotting Time (ACT)

Activated Clotting Time (ACT) The ACT is a standardized measurement of the patients procoagulation or anticoagulation level.  The unit of measurement is the time (in seconds) that is required for an ACT counter to detect the formation of blood clot in a 2-3 milliliter sample of whole blood.  Normal ACT levels range from 100-130 seconds, […]

Coagulopathies & Treatment

Coagulopathies & Treatment The most common cause of intraoperative coagulopathy is thrombocytopenia (decrease in platelet count) secondary to hemodilution.  Blood loss that is replaced by crystalloid volume will progressively dilute platelet numbers as well as platelet entrapment on the surfaces of the extracorporeal circuit.  Associated with bypass is platelet migration to the spleen and reticuloendothelial […]

Coagulation Cascade (V.1)

  Intrinsic Pathway The coagulation cascade is initiated when blood becomes traumatized by exposure to a foreign surface.  An example of this is the initiation of cardiopulmonary bypass.  Blood contact with the polyvinyl chloride tubing utilized in the extracorporeal circuit, the squeezing mechanism of the roller head pump, and various applications of blood filtering devices, […]