ABSTRACT
The changing clinical scene presents some significant problems in diagnosing both hemorrhagic and thrombotic complications associated with modern-day surgical and interventional procedures. These high-risk procedures for bleeding are by their very nature the cause of the bleeding. Transfusion of blood components and specific medications to reduce bleeding are based on a history of preoperative medication as in aspirin use, surgical bleeding as in microvascular oozing, and coagulation testing demonstrating thrombocytopenia and/or hypofibrinogenemia. Platelet dysfunction has been accepted as one of the main causes for excessive postsurgical bleeding in cardiopulmonary bypass patients. Acquired bleeding related to orthopedic surgery is associated with two obvious types of procedures, elective and traumatic repair. Since the late 1980s, when the transmission of viral contaminants in the general blood supply became a major issue, cardiovascular surgery has been challenged to limit postsurgical blood loss. Until that time, a high level of blood usage was a common event in cardiovascular surgery.
