Use of ferric sulfate to control hepatic bleeding

The Advantages and Disadvantages of Methods Used to Control Liver Bleeding: A Review

Context:

Despite advancements in the science of surgery, minimizing bleeding from parenchymal tissue of the liver continues to be one of the challenges surgeons are facing to protect patients’ lives. However, the number of surgeries needing incisions in the liver tissue, e.g. metastatectomy, is constantly increasing.

Evidence Acquisition:

A MEDLINE and conventional search of the past 50 years of the medical literature was performed to identify relevant articles on hemostasis in the liver parenchymal tissue.

Results:

The studies that have been published on hemostasis in the liver parenchymal tissue can be classified into 3 categories: 1. surgical procedures; 2. methods affecting body hemodynamic; 3. pharmacological methods. The purpose of these studies are to identify the best therapeutic approaches that not only minimize the bleeding, but also save the maximum amount of the liver tissue and minimize the use of partial liver resections.

Conclusions:

The excessive blood loss and the long time needed to control the bleeding during liver surgery impose several side effects and complications on patients. Topical hemostatic agents such as ferric chloride, potassium aluminum sulfate (alum) and aluminum chloride are safely applicable in patients. These agents might be used along with other current methods to minimize the blood loss and the need for blood products during liver surgeries.

Efficacy and safety of aluminum chloride in controlling external hemorrhage: an animal model study

Background:

Despite all the progress in surgical science, bleeding caused by traffic accidents is still one of the challenges surgeons face in saving patients’ lives. Therefore, introducing an effective method to control external bleeding is an important research priority.

Objectives:

This study aimed to compare the hemostatic effect of aluminum chloride versus simple suturing in controlling external bleeding.

Materials and Methods:

This experimental study was conducted in Kashan, Iran. In this study, 60 male Wistar rats were randomly allocated into six groups. An incision, two centimeters (cm) long and half a cm deep, was made on each rat’s shaved back skin and the hemostatic time was measured once using aluminum chloride with different concentrations (5%, 10%, 15%, 25%, and 50%) and then using the control method (controlling hemorrhage by simple suturing). The skin tissue was assessed for pathological changes.

Results:

The hemostatic time of aluminum chloride 50%, 25%, 15%, 10% and 5% were 8.20 ± 0.919, 14.10 ± 1.37, 21.20 ± 1.31, 30.80 ± 1.68 and 42.00 ± 4.19 seconds, respectively. Also, the mean hemostasis time in the control group (suture) was 84.00 ± 4.05 seconds. The hemostatic times of different concentrations of aluminum chloride were significantly less than that of the control group. There was a statistically significant difference between every two hemostatic time. The pathologic examination showed the highest frequency of low-grade inflammation based on the defined pathological grading.

Conclusions:

The aluminum chloride method needs less time to control external hemorrhage compared to the control method (controlling external hemorrhage by simple suturing). Aluminum chloride is an effective agent in controlling external hemorrhage in an animal model.