title: A protocol for management of blood loss in surgical treatment of peritoneal malignancy by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
abstract: OBJECTIVE
  The treatment of peritoneal malignancies with cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to be associated with massive surgical blood loss. Maintaining high fibrinogen levels throughout surgery may reduce blood loss in these patients. The primary aim of the study was to see if Tranexamic Acid (TXA) and cryoprecipitate reduced surgical blood loss and hence red cell transfusions. A comparison was made with a cohort of patients treated with fresh frozen plasma (FFP) alone. The secondary aim was to measure the effect of both protocols on coagulation parameters and the incidence of arterial or venous thrombosis.
  
  
  METHODS
  We used prospectively collected data from 201 patients who had complete CRS with HIPEC for peritoneal malignancy using different protocols during two discrete 12-month time periods.
  
  
  RESULTS
  The new transfusion protocol led to a higher average fibrinogen level intra-operatively and post-operatively, with a significant reduction in average RBC, FFP and platelet transfusion intra-operatively per patient from 4·2 to 1·8 units, 6·2 to 0·2 units and 0·1 to 0 units, respectively. No significant difference in PT or APTT was seen between patients treated with the standard and new protocols. Venous thrombosis occurred in seven patients treated with the standard protocol and five with the new protocol. A single case of arterial thrombosis was seen in both groups.
  
  
  CONCLUSIONS
  Patients treated with upfront TXA and cryoprecipitate during CRS required less RBC transfusion than those treated with the standard protocol of early FFP.
authors.affiliation: Department of Haematology, Hampshire Hospitals NHS Trust, Basingstoke, UK.
authors.forename: N
authors.initials: N
authors.lastname: Sargant
authors.affiliation: Department of Haematology, Hampshire Hospitals NHS Trust, Basingstoke, UK.
authors.forename: A
authors.initials: A
authors.lastname: Roy
authors.affiliation: Department of Haematology, Hampshire Hospitals NHS Trust, Basingstoke, UK.
authors.forename: S
authors.initials: S
authors.lastname: Simpson
authors.affiliation: Department of Pseudomyxoma Peritonei Surgery, Hampshire Hospitals NHS Trust, Basingstoke, UK.
authors.forename: K
authors.initials: K
authors.lastname: Chandrakumaran
authors.affiliation: Department of Pseudomyxoma Peritonei Surgery, Hampshire Hospitals NHS Trust, Basingstoke, UK.
authors.forename: S
authors.initials: S
authors.lastname: Alves
authors.affiliation: Department of Anaesthesia, Hampshire Hospitals NHS Trust, Basingstoke, UK.
authors.forename: J
authors.initials: J
authors.lastname: Coakes
authors.affiliation: Department of Anaesthesia, Hampshire Hospitals NHS Trust, Basingstoke, UK.
authors.forename: J
authors.initials: J
authors.lastname: Bell
authors.affiliation: Department of Anaesthesia, Hampshire Hospitals NHS Trust, Basingstoke, UK.
authors.forename: J
authors.initials: J
authors.lastname: Knight
authors.affiliation: Department of Anaesthesia, Hampshire Hospitals NHS Trust, Basingstoke, UK.
authors.forename: P
authors.initials: P
authors.lastname: Wilson
authors.affiliation: Department of Pseudomyxoma Peritonei Surgery, Hampshire Hospitals NHS Trust, Basingstoke, UK.
authors.forename: F
authors.initials: F
authors.lastname: Mohamed
authors.affiliation: Department of Pseudomyxoma Peritonei Surgery, Hampshire Hospitals NHS Trust, Basingstoke, UK.
authors.forename: T
authors.initials: T
authors.lastname: Cecil
authors.affiliation: Department of Pseudomyxoma Peritonei Surgery, Hampshire Hospitals NHS Trust, Basingstoke, UK.
authors.forename: B
authors.initials: B
authors.lastname: Moran
mesh_terms: D016913:Blood Component Transfusion; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005169:Factor VIII / Q000008:administration & dosage*; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000097:blood / Q000628:therapy*; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control; D011446:Prospective Studies; D014148:Tranexamic Acid / Q000008:administration & dosage*; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control
chemical_list: C026912:cryoprecipitate coagulum; D014148:Tranexamic Acid; D005169:Factor VIII; D005340:Fibrinogen
keywords: Haemorrhage; Pseudomyxoma peritonei; surgical blood loss