TY  - CHAP
M1  - Book, Section
TI  - Chapter 51. Fluid Management & Blood Component Therapy
A1  - Butterworth, John F.
A1  - Mackey, David C.
A1  - Wasnick, John D.
PY  - 2013
T2  - Morgan & Mikhail's Clinical Anesthesiology, 5e
AB  - Although  the  intravascular  half-life  of  a  crystalloid  solution  is  20-30  min,  most  colloid  solutions  have  intravascular  half-lives  between  3  and  6  h.  Patients  with  a  normal  hematocrit  should  generally  be  transfused  only  after  losses  greater  than  10-20%  of  their  blood  volume.  The  exact  point  is  based  on  the  patient’s  medical  condition  and  the  surgical  procedure.  The  most  severe  transfusion  reactions  are  due  to  ABO  incompatibility;  naturally  acquired  antibodies  can  react  against  the  transfused  (foreign)  antigens,  activate  complement,  and  result  in  intravascular  hemolysis.  In  anesthetized  patients,  an  acute  hemolytic  reaction  is  manifested  by  a  rise  in  temperature,  unexplained  tachycardia,  hypotension,  hemoglobinuria,  and  diffuse  oozing  in  the  surgical  field.  Allogeneic  transfusion  of  blood  products  may  diminish  immunoresponsiveness  and  promote  inflammation.  Immunocompromised  and  immunosuppressed  patients  (eg,  premature  infants,  organ  transplant  recipients,  and  cancer  patients)  are  particularly  susceptible  to  severe  transfusion-related  cytomegalovirus  (CMV)  infections.  Ideally,  such  patients  should  receive  only  CMV-negative  units.  The  most  common  cause  of  nonsurgical  bleeding  following  massive  blood  transfusion  is  dilutional  thrombocytopenia.  Clinically  important  hypocalcemia,  causing  cardiac  depression,  will  not  occur  in  most  normal  patients  unless  the  transfusion  rate  exceeds  1  unit  every  5  min,  and  intravenous  calcium  salts  should  rarely  be  required  in  the  absence  of  measured  hypocalcemia.  Once  adequate  tissue  perfusion  is  restored,  the  most  consistent  acid-base  abnormality  following  massive  blood  transfusion  is  metabolic  alkalosis,  caused  by  the  rapid  hepatic  metabolism  of  citric  acid  and  lactic  acid  to  bicarbonate.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2021/02/24
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=57239388
ER  -