Thread: Blood conservation.

I recently had a surgeon tell me that when using the heart lung machine plus cell salvage that they also do something called a wrap.
What exactly is that?

Also is EPO plus iron plus folic acid plus vitamin12 effective for after open heart , when there has been serious blood loss?
I f so what are the correct dosages?

When trying to get a blood count up prior to surgery which is more effective.
Once a week shots of EPO 42,000 units, or a lower dosage given every other day?

What the surgeon told you is probably RAP which stands for Retrograde Autologous Prime. In order to prime the heart-lung machine for optimum blood conservation and less dilution of clotting factors, the perfusionist sends the patient's blood backwards through the tubing to prime the pump. This method is superior because it cause less dilution of the patients blood. It is also important at the end of the case to return all of the blood left in the tubing back to the patient before disconitnuing by-pass.

The most effective way to correct anemia preoperatively depends on the cause of the anemia. Besides getting the 'blood count' or hemoglobin, the patient should also be checked for iron deficiency. Available iron is essential for the epo to work. In fact, in many cases IV iron will correct the anemia without using epo. We use the Cleveland Clinic algorthim which starts with a hemoglobin equal to or below 12g/dL. Next we look at the mcv. For mcv below 80, we check iron studies and give IV iron for ferritin and transsferrin below 20. For mcv between 80 and 95, we give epo and oral iron. For mcv above 95, we send to a hematologist for a complete work-up.
When patients are optimized pre-op, usually there is no need to treat post op. Between controlling introperative blood loss through meticulous hemostasis and all of the intraoperative blood conservation strategies (RAP, cell salvage, ANH, etc) patients leave the OR with decent hemoglobins.
If your surgeon is talking about treating anemia postoperatively, I would be wary. Patients should not need anemia correction postoperatively if the pre-op and intra-op phases are handled correctly.
The correct weekly dose of epo is 40,000 units. Typically we see a one gram rise in hemoglobin per week of pre-op treatment. The reason for this is physiologic. Red cells take a week to reach maturity. Epo does not speed up that process. It just helps produce more red cells, just not any faster.
I hope these explanations help.