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Preoperative anemia management in the coronavirus disease (COVID-19) era [Editorial]

Perelman, Seth I; Shander, Aryeh; Mabry, Christian; Ferraris, Victor A
PMID: 34173552
ISSN: 2666-2736
CID: 4925952

Left Atrial Appendage Thrombus Formation after Perioperative Cardioversion in the Setting of Severe Rheumatic Mitral Stenosis

Gorbaty, Benjamin J; Perelman, Seth; Applebaum, Robert M
PMID: 32482503
ISSN: 1532-8422
CID: 4468722

Essentials of Blood Product Management in Anesthesia Practice

Scher, Corey S; Kaye, Alan David; Liu, Henry; Perelman, Seth; Leavitt, Sarah
Cham : Springer International Publishing AG, 2021
Extent: 469 p.
ISBN: 3030592952
CID: 4832062

When Blood Is Not an Option: Care of the Jehovah’s Witness Patient

Chapter by: Feit, Justin B; Perelman, Seth
in: Essentials of Blood Product Management in Anesthesia Practice by Scher, Corey S; Kaye, Alan David; Liu, Henry; Perelman, Seth; Leavitt, Sarah (Eds)
Cham : Springer International Publishing AG, 2021
pp. 135-140
ISBN: 3030592952
CID: 4836872

Standards and Best Practice for Acute Normovolemic Hemodilution: Evidence-based Consensus Recommendations

Shander, Aryeh; Brown, James; Licker, Marc; Mazer, David C; Meier, Jens; Ozawa, Sherri; Tibi, Pierre R; Van der Linden, Phillipe; Perelman, Seth
OBJECTIVE:To develop a standardized approach to the implementation and performance of acute normovolemic hemodilution (ANH) in order to reduce the incidence of bleeding and allogeneic blood transfusion in high-risk surgical bleeding-related cardiac surgery with cardiopulmonary bypass (CPB). DESIGN/METHODS:A 2-round modified RAND-Delphi consensus process. PARTICIPANTS/METHODS:Seven physicians from multiple geographic locations and clinical disciplines including anesthesiology and cardiac surgery and 1 cardiac surgery perfusionist participated in the survey. One registered nurse, specializing in Patient Blood Management, participated in the discussion but did not participate in the survey. METHODS:A modified RAND-Delphi method was utilized that integrated evidence review with a face-to-face expert multidisciplinary panel meeting, followed by repeated scoring using a 9-point Likert scale. Consensus was determined as a result from the second round survey, as follows: median rating of 1-3: ANH acceptable; median rating of 7-9: ANH not acceptable; median rating of 4-6: use clinical judgment. RESULTS:Evidentiary review identified 18 key peer-reviewed manuscripts for discussion. Through the consensus-building process, 39 statements including 26 contraindications to ANH and 10 CPB patient variables were assessed. In total, 22 statements were accepted or modified for the second scoring round. CONCLUSIONS:Consensus was reached on 6 conditions in which ANH would or would not be acceptable, showing that development of a standardized approach for the use of ANH in high-risk surgical bleeding and allogeneic blood transfusion is clearly possible. The recommendations developed by this expert panel may help guide the management and inclusion of ANH as an evidence and consensus-based blood conservation modality.
PMID: 32127266
ISSN: 1532-8422
CID: 4340622

Perioperative Anemia: Prevention, Diagnosis, and Management Throughout the Spectrum of Perioperative Care

Warner, Matthew A; Shore-Lesserson, Linda; Shander, Aryeh; Patel, Sephalie Y; Perelman, Seth I; Guinn, Nicole R
Anemia is common in the perioperative period and is associated with poor patient outcomes. Remarkably, anemia is frequently ignored until hemoglobin levels drop low enough to warrant a red blood cell transfusion. This simplified transfusion-based approach has unfortunately shifted clinical focus away from strategies to adequately prevent, diagnose, and treat anemia through direct management of the underlying cause(s). While recommendations have been published for the treatment of anemia before elective surgery, information regarding the design and implementation of evidence-based anemia management strategies is sparse. Moreover, anemia is not solely a concern of the preoperative encounter. Rather, anemia must be actively addressed throughout the perioperative spectrum of patient care. This article provides practical information regarding the implementation of anemia management strategies in surgical patients throughout the perioperative period. This includes evidence-based recommendations for the prevention, diagnosis, and treatment of anemia, including the utility of iron supplementation and erythropoiesis-stimulating agents (ESAs).
PMID: 32167979
ISSN: 1526-7598
CID: 4349922

Implementation of a Preoperative Anemia Clinic Utilizing a Minimal Staffing Model

Mabry, Christian; Perelman, Seth; Kim, Jung T; Blitz, Jeanna D
We present a process map for the implementation of a program to treat preoperative anemia utilizing 1 existing anesthesiologist in the preoperative evaluation clinic. In the first 7 months postimplementation, 342 patients were screened for anemia, 166 were diagnosed, and 107 were treated. The mean increase in hemoglobin in treated patients was ~2 g/dL (range 0-4.9 g/dL). Two patients' surgeries were delayed in favor of treatment and 3 surgical patients, who had received 2 complete iron infusions, received an intraoperative transfusion. The total revenue generated for the institution was enough to subsidize the cost of an additional anesthesiologist.
PMID: 31770131
ISSN: 2575-3126
CID: 4215882

Artificial blood

Chapter by: Shander, Aryeh; Javidroozi, Mazyar; Perelman, Seth
pp. 271-288
CID: 1935172

From bloodless surgery to patient blood management

Shander, Aryeh; Javidroozi, Mazyar; Perelman, Seth; Puzio, Thomas; Lobel, Gregg
Safety and efficacy concerns of allogeneic blood transfusions and their impact on patient outcomes and associated staggering costs and restricted supply have fueled the quest for other modalities and strategies to reduce use of blood components. Patient blood management focuses on multidisciplinary and multimodal preventive measures to reduce or obviate the need for transfusions and ultimately to improve the clinical outcomes of patients. Patient blood management strategies can be applied at every stage of care to surgical and nonsurgical patients, and they generally fall under one of these three categories (the so-called pillars of blood management): optimizing hematopoiesis and appropriate management of anemia, minimizing bleeding and blood loss, and harnessing and optimizing physiological tolerance of anemia through employing all available modalities while treatment is initiated. Several tools and modalities are available to address each of these pillars. Examples include hematinic agents, systemic and topical hemostatic agents, autotransfusion, and blood-sparing perfusion and surgical techniques. Additionally, changes in practice of clinicians (e.g., adherence to restrictive, evidence-based transfusion strategies with emphasis on physiologic indications for transfusion, minimization of iatrogenic blood loss, and adequate planning) play an important role in patient blood management. Emerging evidence supports that appropriate use of these strategies as part of a multimodal program is a safe and effective way of reducing allogeneic transfusions and improving patient outcomes.
PMID: 22238039
ISSN: 1931-7581
CID: 1934592

Postoperative blood loss and transfusion associated with use of Hextend in cardiac surgery patients at a blood conservation center

Moskowitz, David M; Shander, Aryeh; Javidroozi, Mazyar; Klein, James J; Perelman, Seth I; Nemeth, Jeffrey; Ergin, M Arisan
BACKGROUND: Hydroxyethyl starch (HES) solutions are readily available colloids, but their widespread use is shadowed by controversies surrounding their effects on bleeding. This retrospective study was conducted to evaluate the relationship between Hextend (HEX; Hospira, Inc.) doses of 1 to 20 mL/kg and allogeneic transfusion and 24-hour chest tube drainage (CTD) in cardiac surgeries at a blood conservation center. STUDY DESIGN AND METHODS: After institutional review board approval, data on 748 patients undergoing coronary artery bypass grafting (CABG), valve, or combined CABG and valve surgeries were collected. Cases not receiving HEX (due to contraindications, e.g., renal failure, bleeding diathesis) or receiving more than 20 mL per kg HEX, not accepting transfusions, or requiring more extensive surgery were excluded, and the remaining 621 cases were analyzed. RESULTS: Overall transfusion rate and mean CTD were 12.7 percent and 460.4 mL, respectively. Patients who received transfusions received more HEX (10.8 mL/kg vs. 9.8 mL/kg; p = 0.043) but HEX per kg was not associated with higher transfusion rates in multivariate analysis (p = 0.077). HEX per kg was associated with CTD in both uni- and multivariate analyzes (p < 0.001) with 1.66 percent increase in CTD for every 1 mL per kg increase in HEX. CONCLUSIONS: Although HEX was associated with transfusion in univariate analysis and with CTD in uni- and multivariate analysis, the former was no longer significant when adjusted for other predictors of transfusion in our selected patient population at a blood conservation center. The clinical significance of the observed increase in CTD remains undetermined. To minimize transfusion and bleeding in these patients, it is recommended that HEX be used in amounts of not more than 20 mL per kg together with point-of-care coagulation tests and other blood conservation strategies.
PMID: 18248568
ISSN: 0041-1132
CID: 1934602