title: Mobile Laboratory Unit: a disruptor solution for hemostasis management during major surgery. Usage in the context of face transplantation.
abstract: BACKGROUND
  The management of surgical bleeding during a face transplant in a patient diagnosed with bilateral neurofibromatosis is quite complex. With the actual methods and technology for hemostasis management, it may not always be possible to give the clinician the support needed to manage operative associated bleeding. Bedside hemostasis monitors are needed urgently to assist clinicians in making the correct diagnosis in a timely manner.
  
  
  METHODS
  Our Mobile Laboratory Unit is a disruptive solution for hemostasis management during major surgery as it allows real-time monitoring, the predominant mechanism of bleeding and goal-direct coagulation therapy. The unit is an autonomous mobile platform that can be moved immediately to anywhere its service is needed and offers a complete flexible laboratory test which includes biochemistry, hematology and coagulation studies as standard equipment.
  
  
  RESULTS
  In our case the test performed by the unit allowed us to identify the reason for our patient's bleeding at the bedside. Severely decreased clot firmness of the fibrin-based clot and a less impaired firmness of the whole blood clot, suggested an acceptable contribution of platelets to the clot quality, but decreased polymerization of fibrinogen into fibrin.
  
  
  CONCLUSIONS
  In our opinion new insights into the pathophysiology of coagulopathy, the availability of technology such as our Mobile Laboratory Unit, and awareness of side effects of intravenous fluids should encourage the idea that perhaps it is time to change hemostasis management in operation-related bleeding.
authors.affiliation: Department of Clinical Laboratory Sciences, Virgen del Rocío University Hospital, Seville, Spain. antonio.leonj.sspa@juntadeandalucia.es
authors.forename: Antonio
authors.initials: A
authors.lastname: Leon-Justel
authors.forename: Jose Angel
authors.initials: JA
authors.lastname: Noval-Padillo
authors.forename: Franciso
authors.initials: F
authors.lastname: Polonio
authors.forename: Tomas
authors.initials: T
authors.lastname: Gomez-Cia
authors.forename: Rafael
authors.initials: R
authors.lastname: Hinojosa
authors.forename: Manuel
authors.initials: M
authors.lastname: Porras
authors.forename: Jose M
authors.initials: JM
authors.lastname: De-Blas
authors.forename: Cristina
authors.initials: C
authors.lastname: Solomon
authors.forename: Juan M
authors.initials: JM
authors.lastname: Guerrero
mesh_terms: D000328:Adult; D001780:Blood Coagulation Tests / Q000295:instrumentation*; D001784:Blood Gas Analysis / Q000295:instrumentation*; D001792:Blood Platelets / Q000378:metabolism; D054445:Facial Transplantation; D005340:Fibrinogen / Q000378:metabolism; D006470:Hemorrhage; D006801:Humans; D008297:Male; D009456:Neurofibromatosis 1 / Q000601:surgery; D013916:Thrombelastography
chemical_list: D005340:Fibrinogen