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Measuring Intraoperative Blood Loss�

Fredrick Wambu

The Nairobi Hospital

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Background

  • Approximately 300 million operations are performed worldwide
  • No standardized method for measuring intra-operative blood loss
  • Current data on existing methods is very broad-No consensus
  • Blood loss during surgery is estimated visually by the surgical team
  • Estimation of blood loss prone to errors
  • Standardized Evidence based methods needed

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Objectives

  • Scoping review
    • Establish currently available methods for measuring intraoperative blood loss.
    • Determine the current status, map and summarize the available evidence for measuring blood loss
    • Identify gaps in literature

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Methodology (studies 2014-2024)- PRISMA-ScR  Guideline

  • Systematic literature review
  • Preselection criteria
  • Intervention study (Randomized control trial &controlled clinical trial )
  • Observation study (Case control study &cohort study)
  • Surgical specialty (All)
  • Type of procedure
  • Measurement method
  • Blood loss as a primary outcome

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  • Exclusion
  • Reviews
  • Case reports
  • Case series with less than 5 patients
  • Commentaries
  • Letters

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Blood Loss Estimation Methods

Visual Estimation

  • Commonly used
  • Collection containers
  • Abdominal drapes
  • Blood on the floor
  • Overestimation
  • Underestimation

Visual Blood Loss Estimation Guide

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Blood Loss Estimation Methods

  • Gravimetric
  • Weighing surgical material saturated with blood 
  • Subtracting the dry weight of the material
  • Each gram considered as 1ml of Blood loss

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Accuracy of Gravimetric Method of Blood Loss Estimation during Open Myomectomy

Osakwe, Chukwudi R.; Mbachu, Ikechukwu I; Osakwe, Oluchi J.; More

  • International Journal of Medicine and Health Development. 28(3):245-250, Jul-Sep 2023.

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Gravimetric Blood Loss Estimation

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Direct measurements –Estimated

  • Suction bottle calibrated
  • Drapes with collection pouches

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Calculated Blood Loss-Nadler& Gross Equation

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Calculated blood loss-Lab Values

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Calculated method

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Colorimetric Blood Loss Estimation

  • Innovative mobile app calculates the estimated blood loss by taking photos of used surgical gauze and canisters.

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Colorimetric Blood Loss Estimation

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Colorimetric Blood Loss Estimation

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Pro & Cons of Techniques

  • Green= Excellent .Yellow= Moderate , Red =Extremely Poor

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Limitations

  •  Published literature in English
  • Articles were filtered based solely on titles and abstracts, potentially resulting in the exclusion of other relevant articles

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Conclusions

  • Healthcare professionals should be aware of the low accuracy of the Visual Estimation of Blood Loss method
  • Each assessment method has its limitations
  • Accurate assessment of blood loss combined with vital signs, physiological indicators and other factors is necessary
  • Measurement of intraoperative blood loss lacks clarity due to the absence of standardized methods
  • Expanding the evidence base around intraoperative blood loss measurement is an important research priority.

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References

  • Hazarika, N., Kaur, A. P., & Madan, A. (2022). A comparative study of postpartum blood loss by visual estimation method and by gravimetric method. Asian Journal of Pharmaceutical and Clinical Research, 15, 127–130. https://doi.org/10.22159/ajpcr.2022.v15i7.44589
  • Madar, H., Sentilhes, L., Goffinet, F., Bonnet, M. P., Rozenberg, P., & Deneux-Tharaux, C. (2023). Comparison of measured and calculated postpartum blood loss after vaginal delivery. American Journal of Obstetrics and Gynecology, 226, 562–563. https://doi.org/10.1016/j.ajog.2021.11.931