Practical understanding of hemostasis and approach to the bleeding patient in the OR

Design of nanoconstructs that exhibit enhanced hemostatic efficiency and bioabsorbability

Hemorrhage is a prime cause of death in civilian and military traumatic injuries, whereby a significant proportion of death and complications occur prior to paramedic arrival and hospital resuscitation. Hence, it is crucial to develop hemostatic materials that are able to be applied by simple processes and allow control over bleeding by inducing rapid hemostasis, non-invasively, until subjects receive necessary medical care. This tutorial review discusses recent advances in synthesis and fabrication of degradable hemostatic nanomaterials and nanocomposites. Control of assembly and fine-tuning of composition of absorbable (i.e., degradable) hemostatic supramolecular structures and nanoconstructs have afforded the development of smart devices and scaffolds capable of efficiently controlling bleeding while degrading over time, thereby reducing surgical operation times and hospitalization duration. The nanoconstructs that are highlighted have demonstrated hemostatic efficiency pre-clinically in animal models, while also sharing characteristics of degradability, bioabsorbability and presence of nano-assemblies within their compositions.

Effect of Broccoli (Brassica oleracea L. var. italica) Extract on Bleeding Time in Male White Mice (Mus musculus L.)

Cessation of bleeding is influenced by many factors including the type of medication used. The use of drugs to stop bleeding can be done in various ways, one of which is the use of traditional medicine. One of the traditional plants that can be used as a stop bleeding is broccoli (Brassica oleracea L. var. italica) which has a fairly high vitamin K content, where is efficacious as hemostatic. This study aims to determine the effect of broccoli on the bleeding time of mice tail cuts. The first group was negative control (Na-CMC), the second group was positive control (tranexamic acid), while groups three, four, and five were broccoli extract dose of 20, 40, and 60 mg/kg BW, respectively. All treatments were given orally for seven days. Bleeding time was calculated from the initial blood loss until the blood stopped (tail bleeding I method) and the data were analyzed with the ANOVA one way test and the post hoc Least Significant Difference (LSD) statistical test. The results showed that there were differences in the time to stop bleeding in the treatment control group at a dose of 20 mg/kg BW (122.60 � 29.535 seconds), 40 mg/kg BW (102.40 � 9.607 seconds) and 60 mg/kg BW (90.40 � 3.845 seconds). From these results, it can be concluded that the extract of broccoli at a dose of 60 mg/kg BW gives the best results as hemostatic, while the effect is almost similar to the positive control group.

[Hypovolemic and hemorrhagic shock]

The term "shock" refers to a life-threatening circulatory failure caused by an imbalance between the supply and demand of cellular oxygen. Hypovolemic shock is characterized by a reduction of intravascular volume and a subsequent reduction in preload. The body compensates the loss of volume by increasing the stroke volume, heart frequency, oxygen extraction rate, and later by an increased concentration of 2,3-diphosphoglycerate with a rightward shift of the oxygen dissociation curve. Hypovolemic hemorrhagic shock impairs the macrocirculation and microcirculation and therefore affects many organ systems (e.g. kidneys, endocrine system and endothelium). For further identification of a state of shock caused by bleeding, vital functions, coagulation tests and hematopoietic procedures are implemented. Every hospital should be in possession of a specific protocol for massive transfusions. The differentiated systemic treatment of bleeding consists of maintenance of an adequate homeostasis and the administration of blood products and coagulation factors.

Transfusion Medicine and Coagulation Management in Organ Transplantation

Organ transplantation recipients present unusual challenges with regard to blood transfusion. Although this patient population requires a larger proportion of blood product resources, liberal transfusion of allogeneic blood products can lead to a plethora of complications. Recent trends suggest that efforts to minimize bleeding, conserve products, and target transfusion to specific deficits and needs are increasingly becoming the standard practice; these must all occur with optimization of graft function and preservation in mind. With newer monitoring modalities and factor concentrates, the approach toward transfusion and bleeding in organ transplantation has rapidly improved in recent years.