![]() ![]() The diagnosis of disseminated intravascular coagulation (DIC) can be made or excluded on the basis of an integrated dynamic evaluation of the clinical picture, laboratory data and of the patient’s underlying pathology ( Grade of recommendation: 2C) 20. PT and aPTT are fundamental laboratory parameters which, in the presence of haemorrhage, guide the therapeutic decision regarding transfusion of fresh-frozen plasma (FFP) 18. The platelet count is one of the decisional parameters for platelet transfusion, along with the clinical evaluation of the patient ( Grade of recommendation: 2C) 17 – 19. ![]() increased O 2 consumption: fever, pain, stress, sepsis, SIRS, hyperventilation syndromes. altered gas exchange: chronic obstructive pulmonary disease (COPD), ARDS impaired ability to increase O 2 extraction: acute respiratory distress syndrome (ARDS), sepsis, systemic inflammatory response syndrome (SIRS), syndrome of ischaemia-reperfusion injury ![]() limited increase in the cardiac output: hypovolaemia, coronary artery disease, disorders of heart valves, congestive heart disease, negative inotropes The physiological mechanisms of adaptation to anaemia (increased cardiac output, increased coronary artery blood flow, redistribution of blood flow, increased O 2 extraction, increased red blood cell 2,3-diphosphoglycerate) can be affected by 7, 10 – 16: the demand for O 2, that is, the volume of O 2 necessary for tissues to carry out their aerobic function. the saturation of Hb, which in its turn is dependent on the oxygen (O 2) tension and the affinity of Hb for O 2 Tissue oxygenation depends on various factors 10: The intracellular partial pressure of oxygen (pO 2) represents the decisional parameter “of choice” for evaluating tissue hypoxia 7 – 9 it cannot, however, be used in clinical practice and for this reason Hb and Htc, which are “surrogate” parameters, are used 10. It has also been suggested that the evaluation of the patient is targeted to detect the presence of abnormal microvascular bleeding, a sign of coagulopathy ( Grade of recommendation: 2C) 5. This estimate can be difficult in obstetric cases if the blood lost remains within the uterus, in the broad ligament or in the peritoneal cavity, with modest or no signs of external bleeding: it is, therefore, suggested that particular attention should be paid to evaluating clinical signs of haemorrhagic shock ( Grade of recommendation: 2C) 6. The evaluation of blood loss should be based on the volume of blood removed from the surgical field by aspirators and that absorbed by gauzes and swabs. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, antithrombin (AT), D-dimer. Signs of inadequate perfusion and oxygenation of the vital organs The correct intra-operative management of the patient includes evaluation and monitoring of the following parameters 5: Management of the patient in the intra-operative period ![]()
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