Adequate perioperative analysis of hemostasis taking into account also disorders of primary hemostasis considerably contributes to prevention, early detection, and appropriate treatment of hemostatic disturbances. However, laboratory analysis has to be topically performed. Exact documentation of the time of sampling and documentation of intermittent replacement of blood products or blood loss is necessary in order to relate the laboratory results to the actual clinical situation. Assessment of ‘point of care’ methods is still controversial. For the surgeon thorough local control of hemorrhage is top priority. Standard transfusion protocols are advisible in massive transfusion with respect to logistic problems. We describe an effective standard protocol being based on the initial administration of blood components (red cell concentrates, plasma, platelet concentrates) in a certain fixed ratio which then is adapted according to the laboratory test results and the clinical situation of the patient. In addition, as soon as the hemostasis shows critical threshold values, coagulation factor concentrates (prothrombin complex, fibrinogen, seldom single coagulation factors) are administered. Furthermore, desmopressin and antifibrinolytics can be successfully used in disorders of primary hemostasis, and additionally antifibrinolytics in hyperfibrinolysis or even unclear diffuse bleeding.

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© 2001 S. Karger GmbH, Freiburg
2001
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