C.L., a 16-year-old girl, sustained a ruptured liver when she hit a tree while sledding. Emergency surgery was needed to stop the internal bleeding. During surgery, the ruptured segment of the liver was removed and the laceration was sutured with a heavy, absorbable suture on a large smooth needle. Before surgery, her hemoglobin was 10.2 g/dL, but the reading decreased to 7.6 g/dL before hemostasis was attained. Cell salvage, or autotransfusion, was set up. In this procedure, the free blood was suctioned from her abdomen and mixed with an anticoagulant (heparin). The RBCs were washed in a sterile centrifuge with NSS and transfused back to her through tubing fitted with a filter. She also received 6 units of homologous, leukocyte-reduced whole blood, 5 units of fresh frozen plasma, and 2 units of platelets. During the surgery, the CRNA repeatedly tested her Hgb and Hct as well as prothrombin time and partial thromboplastin time to monitor her clotting mechanisms.
C.L. is B positive. Fortunately, there was enough B-positive blood in the hospital blood bank for her surgery. The lab informed her surgeon that they had 2 units of B-negative and 6 units of O-negative blood, which she could have received safely if she needed more blood during the night. However, her hemoglobin level increased to 12 g/dL, and she was stable during her recovery. She was monitored for DIC and pulmonary emboli.
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