الفهرس 
Emergency Medicine and Critically ill patientsOnly 14 pages are availabe for public view
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Abstract
Blood transfusions are commonly administered to critically ill patients. Although they can be life-saving, they are also associated with adverse events. Reducing blood loss and the need for blood transfusions and improving the appropriateness of blood transfusion are important quality of care issues for critically ill patients. A variety of strategies exist to reduce the need for blood transfusions in critically ill patients. These strategies include the use of hemostatic agents, erythropoietin, hemoglobin substitutes , autologous blood transfusion, the reduction of blood loss associated with diagnostic testing, restrictive blood transfusion triggers, anesthetic methods and surgical methods. Pharmacologic agents used in blood conservation can either reduce or stop bleeding or decrease the like-lihood of transfusion by raising hemoglobin. Recombinant erythropoietin and other erythropoietin-receptor agonists are commonly used in patients who have chronic renal failure or cancer with bone marrow suppression, to increase hemoglobin levels and avoid the need for blood transfusions. Recombinant erythropoietin has also been used in critically ill patients for the same purpose. Desmopressin has been used successfully in the prevention or treatment of bleeding due to minor surgical procedures in mild hemophilia A and type I Von Willebrand’s disease. Desmopressin is also efficacious for indications not involving FVIII and von Willebrand factor. Notably, it shortens the bleeding time in patients with certain acquired platelet function disorders (chronic renal failure, acetyl-salicylic acid intake). Aprotinin has been used in various types of operations, mainly cardiac, hepatic and orthopedic surgery. Neither the optimal dose of aprotinin nor the appropriate therapeutic concentrations required for effective hemostasis have been established definitively. As a consequence, many different dosing regimens have been used. The classical ”Full Hammersmith regimen” calls for an initial dose of 2 × 106 KIU (280 mg) followed by a maintenance infusion of 500,000 KJU hr-1 (70 mg.hr-1), with another 2 ×106 KIU added to the CPB pump prime solution. Lysine Analogues this group of drugs includes epsilon-aminocaproic acid (EACA) and tranexamic acid (TxA) . Both drugs have been widely used to prevent or treat bleeding during tooth extraction in haemophilia and some other coagulation disorders ,They are used mainly to reduce blood loss and transfusion in CPB surgery and liver transplantation.