Fig 2 - available from: Journal of Clinical Monitoring and Computing
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Pros and cons of blood loss estimation methods. Pros and cons of blood loss estimation methods are presented. Red = extremely poor, yellow = moderate; green = excellent
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![Fig. 3 Bias of Hb [g] measurements with colorimetric method. Bias of Hb...](publication/343756369/figure/fig3/AS:942192394768385@1601647580309/Bias-of-Hb-g-measurements-with-colorimetric-method-Bias-of-Hb-g-measurements-with_Q320.jpg)
![Fig. 4 Bias of blood volume [ml] estimates with colorimetric method....](publication/343756369/figure/fig4/AS:942192394764288@1601647580335/Bias-of-blood-volume-ml-estimates-with-colorimetric-method-Bias-of-blood-volume-ml_Q320.jpg)
Estimating intraoperative blood loss is one of the daily challenges for clinicians. Despite the knowledge of the inaccuracy of visual estimation by anaesthetists and surgeons, this is still the mainstay to estimate surgical blood loss. This review aims at highlighting the strengths and weaknesses of currently used measurement methods. A systematic...
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Citations
... However, in our systematic review and meta-analysis, significant heterogeneity was observed in the blood loss volume analysis, mainly due to differences in surgery type, blood loss volume calculation method (Gerdessen et al. 2021;Sokoliuk and Levchenko 2022), and TXA dose (Taam et al. 2020;Lam et al. 2023). There may be significant differences in blood loss volume between different surgeries, such as breast aesthetic surgery, liposuction, or rhinoplasty. ...
Introduction
Tranexamic acid has been widely used in plastic surgery. However, its efficacy has yet to be fully established. This meta-analysis aimed to determine its effectiveness in aesthetic plastic surgery.
Methods
Following PRISMA guidelines, we conducted a meta-analysis of prospective randomised clinical trials that compared the effects of topical or systematic administration of tranexamic acid versus the control group in aesthetic plastic surgeries. The study was registered on the International Register of Systematic Reviews (PROSPERO) and is available online (www.crd.york.uk/prospero, CRD42023492585).
Results
Eleven studies encompassing 960 patients were included for the synthesis after critical evaluation. Systematic (MD − 18.05, 95% Cl, − 22.01, − 14.09, p < 0.00001) and topical (MD − 74.93, 95% Cl, − 88.79, − 61.07, p < 0.00001) administration of tranexamic acid reduced total blood loss. Topical tranexamic acid reduced drainage output (p < 0.0006).
Conclusion
Tranexamic acid reduced blood loss in aesthetic plastic surgery. More strictly defined RCTs, using high-quality methodology, are needed to evaluate the advantages and disadvantages of tranexamic acid in aesthetic plastic surgery.
... While there is no definitive evidence favouring one method over the other, quantitative estimation offers greater precision than subjective assessment. Although obstetrics and gynaecology societies advocate for quantitative estimation methods, including weighing blood-soaked materials and monitoring fluid usage during irrigation, equipping all medical facilities in Vietnam with the necessary equipment for blood loss measurement is currently impossible and unfeasible [32]. ...
Postpartum haemorrhage remains a significant contributor to maternal mortality and morbidity worldwide, particularly in low- and middle-income countries. PPH continues to pose challenges in both developed and developing nations despite being preventable. This review examines the current state of knowledge regarding PPH within the context of Vietnam, a country with its unique healthcare landscape. This review identifies critical areas for improvement and future research directions based on a comprehensive literature analysis, including epidemiological insights, risk factors, prevention strategies, and management approaches. Discrepancies in PPH definitions and prevalence rates across regions highlight the need for tailored interventions and policies. Understanding the specific challenges and opportunities related to PPH in Vietnam is crucial for informing evidence-based interventions and policies to improve maternal health outcomes. This review contributes to the broader global effort to reduce maternal mortality by addressing gaps in knowledge and proposing strategies to enhance PPH prevention and management in Vietnam.
... Documentation of estimated blood loss in our study and in literature fails to reach >90%. Visual estimation is the most used method for recording intraoperative blood loss and is generally performed poorly in the operating theatre (14). A systematic review by Tran et al. (2020) found that visual estimated blood loss was underestimated in 12 out of 13 studies (15). ...
Objective: Operation notes are important for care in surgical patients. The objectives of this study were to analyze the emergency general surgery (EGS) operation note documentation in accordance with the Royal College of Surgeons of England (RCSEng) guidelines and to assess the impact of creating awareness of the guidelines and effect of a new proforma.
Material and Methods: A retrospective review of 50 EGS operation notes was conducted between December 2019 and March 2020 and compared to RCSEng guidelines. Education was delivered on the importance of documentation in accordance with RCSEng guidelines. A new electronic proforma was introduced. A further 50 EGS operation notes were analysed between August 2020 and December 2020.
Results: One hundred operation notes were reviewed, and each given a score out of 19. Our interventions showed significant improvement to the average score (15.64 vs 17.96; p< 0.001). Within the second cycle, there was a statistically significance difference when comparing electronic to handwritten notes (18.55 vs 17.50; p= 0.001).
Conclusion: Implementation of the new proforma showed improvement in operation note documentation when compared to the RCSEng standard. Therefore, this study emphasizes the need for surgeons to familiarize themselves with the current guidelines.
... The indicator that best reflects the clinical efficacy and surgical safety of PD is bleeding because bleeding has the most direct impact on the patient's prognosis and survival. There are many methods for estimating blood loss [4,5], such as the gravimetric method, formula method, colorimetric method, and visual inspection method. The most commonly used method in clinical practice is visual inspection. ...
... We often describe intraoperative bleeding through IEBL and the blood transfusion rate. There are many methods to estimate intraoperative blood loss [4,5], such as the gravimetric method, formula method, visual inspection method, etc. The more commonly used method in clinical practice is visual inspection [15,16]. ...
BACKGROUND
The common clinical method to evaluate blood loss during pancreaticoduodenectomy (PD) is visual inspection, but most scholars believe that this method is extremely subjective and inaccurate. Currently, there is no accurate, objective method to evaluate the amount of blood loss in PD patients.
AIM
The hemoglobin (Hb) loss method was used to analyze the amount of blood loss during PD, which was compared with the blood loss estimated by traditional visual methods. The risk factors for bleeding were also predicted at the same time.
METHODS
We retrospectively analyzed the clinical data of 341 patients who underwent PD in Shandong Provincial Hospital from March 2017 to February 2019. According to different surgical methods, they were divided into an open PD (OPD) group and a laparoscopic PD (LPD) group. The differences and correlations between the intraoperative estimation of blood loss (IEBL) obtained by visual inspection and the intraoperative calculation of blood loss (ICBL) obtained using the Hb loss method were analyzed. ICBL, IEBL and perioperative calculation of blood loss (PCBL) were compared between the two groups, and single-factor regression analysis was performed.
RESULTS
There was no statistically significant difference in the preoperative general patient information between the two groups (P > 0.05). PD had an ICBL of 743.2 (393.0, 1173.1) mL and an IEBL of 100.0 (50.0, 300.0) mL (P < 0.001). There was also a certain correlation between the two (r = 0.312, P < 0.001). Single-factor analysis of ICBL showed that a history of diabetes [95% confidence interval (CI): 53.82-549.62; P = 0.017] was an independent risk factor for ICBL. In addition, the single-factor analysis of PCBL showed that body mass index (BMI) (95%CI: 0.62-76.75; P = 0.046) and preoperative total bilirubin > 200 μmol/L (95%CI: 7.09-644.26; P = 0.045) were independent risk factors for PCBL. The ICBLs of the LPD group and OPD group were 767.7 (435.4, 1249.0) mL and 663.8 (347.7, 1138.2) mL, respectively (P > 0.05). The IEBL of the LPD group 200.0 (50.0, 200.0) mL was slightly greater than that of the OPD group 100.0 (50.0, 300.0) mL (P > 0.05). PCBL was greater in the LPD group than the OPD group [1061.6 (612.3, 1632.3) mL vs 806.1 (375.9, 1347.6) mL] (P < 0.05).
CONCLUSION
The ICBL in patients who underwent PD was greater than the IEBL, but there is a certain correlation between the two. The Hb loss method can be used to evaluate intraoperative blood loss. A history of diabetes, preoperative bilirubin > 200 μmol/L and high BMI increase the patient's risk of bleeding.
... Quantifying blood loss by visual estimation is a prevalent method. (25) It is considered subjective, under the influence of several variables, including the professional who assesses it. Failures are common, with a tendency to overestimate large losses and underestimate smaller losses. ...
... Failures are common, with a tendency to overestimate large losses and underestimate smaller losses. (11,(25)(26)(27) Like the experts, the literature points out limits to the effective quantification and qualification of blood loss, closely related to the mixing of blood with amniotic fluid or diuresis at birth and the immediate postpartum period, the volume of blood retained in the surgical fields and the differentiation blood loss resulting from episiotomy and/or lacerations. (6,10) Despite the limitations, the comparison between visual estimation versus quantification indicates that quantitative methods are more inclined to more accurate detection of PPH, (11,12,28) with a recommendation for practice. ...
... The association of strategies, such as shock index calculation (result of dividing the heart rate by the systolic blood pressure of postpartum women), (1,2) accurate clinical examination, looking for signs of lipothymia and mucous membrane discoloration during the immediate postpartum period, and measurement of hemoglobin and/or hematocrit levels before and after birth, (6) which appears in the last item of this bundle to be followed depending on each institutional reality, contributes to early and more assertive identification. (23)(24)(25)27) It is also important to highlight that accurate diagnostic methods to quantify postpartum bleeding are effective not only to identify but also to avoid and/or minimize a bad prognosis in cases of already established hemorrhage. (27) Most experts indicated that the constructed bundle is useful and applicable. ...
... Quantifying blood loss by visual estimation is a prevalent method. (25) It is considered subjective, under the influence of several variables, including the professional who assesses it. Failures are common, with a tendency to overestimate large losses and underestimate smaller losses. ...
... Failures are common, with a tendency to overestimate large losses and underestimate smaller losses. (11,(25)(26)(27) Like the experts, the literature points out limits to the effective quantification and qualification of blood loss, closely related to the mixing of blood with amniotic fluid or diuresis at birth and the immediate postpartum period, the volume of blood retained in the surgical fields and the differentiation blood loss resulting from episiotomy and/or lacerations. (6,10) Despite the limitations, the comparison between visual estimation versus quantification indicates that quantitative methods are more inclined to more accurate detection of PPH, (11,12,28) with a recommendation for practice. ...
... The association of strategies, such as shock index calculation (result of dividing the heart rate by the systolic blood pressure of postpartum women), (1,2) accurate clinical examination, looking for signs of lipothymia and mucous membrane discoloration during the immediate postpartum period, and measurement of hemoglobin and/or hematocrit levels before and after birth, (6) which appears in the last item of this bundle to be followed depending on each institutional reality, contributes to early and more assertive identification. (23)(24)(25)27) It is also important to highlight that accurate diagnostic methods to quantify postpartum bleeding are effective not only to identify but also to avoid and/or minimize a bad prognosis in cases of already established hemorrhage. (27) Most experts indicated that the constructed bundle is useful and applicable. ...
Objective: To construct and validate the content of a bundle to quantify vaginal blood loss after childbirth. Methods: This is a methodological study developed from February to August 2022, divided into bibliographic survey, instrument construction and content validity, by 14 experts. The instrument for validity consisted of 11 items selected from a systematic review. For each item in the bundle, a Likert scale was applied, and to check agreement among experts, the Concordance Index was calculated. Items with agreement above 80% were considered valid. Content validity was carried out in a single round of assessment. Results: The final version of the bundle consisted of nine items. The proposed care is related to direct quantification of postpartum bleeding and its recording, observation of postpartum women, use of institutional protocols in cases of postpartum hemorrhage as well as team training. Conclusion: The study allowed constructing and validating a bundle for quantifying vaginal blood loss after childbirth, with a view to improving postpartum hemorrhage diagnosis.
... Several methods are described for measuring or estimating intraoperative blood loss in human and veterinary medicine. Among them, visual estimation (subjective, by surgeon or anesthesiologist), gauzes, sponges and swab weighing method (gravimetric), radioisotopes, weighing the patient before and after the procedure, electrical conductivity, hemodynamic measurements, colorimetric method (hemoglobin), volumetric method (surgical aspirate), direct method (obstetrics), and formulas based on hematocrit values, weight, height, sex, and body area (SHAW & LEWIS, 1981;LEE et al., 2006;JARAMILLO et al., 2019;GERDESSEN et al., 2020;JARAMILLO et al., 2020). ...
... The gold standard for evaluating intraoperative blood loss is the colorimetric method, which uses hemoglobin variations in samples through a spectrophotometer (SHAW & LEWIS, 1981;GERDESSEN et al., 2020). However, this method is considered laborious and not applicable to the surgical routine (LEE et al., 2006). ...
There are no reported estimates of normal or abnormal bleeding in dogs during the hemilaminectomy and intervertebral disc fenestration procedures (HF), and that makes it difficult to study intraoperative complications, hemostasis methods, and the impact of bleeding on surgical performance. This prospective study estimated blood loss during HF procedures in dogs with intervertebral disc extrusion (IVDE). Blood loss was quantified by weighing gauzes during the surgical procedure, in addition to measuring the aspirated blood. Total blood volume was estimated according to body weight, and blood loss as a percentage of the total blood volume. The surgeon also subjectively classified the procedures, dividing them into intraoperative difficulty due to bleeding (G1) and absence of intraoperative difficulty (G2). Thirty-two dogs that underwent HF due to IVDE were included. The median blood loss (%) of dogs submitted to HF was 3.9 ± 9.67 of the total blood volume. There was a weak correlation between blood loss and weight, age, incision size, and procedure time.
... This observation needs to be interpreted cautiously, as it might be related to inaccurate estimation of intraoperative blood loss, as most surgeons rely on visual methods rather than colorimetric and gravimetric methods. 35 Also, most of the studies did not specify the indication of transfusion, institutional protocol for transfusion, number of transfused units, or time of blood transfusion from operation. Therefore, future studies should focus on reporting the method of estimating blood loss, the indication of transfusion, and the time of blood transfusion. ...
Background: Several centers have reported their experience with single-port robot-assisted partial nephrectomy (SP-RAPN); however, it is uncertain if utilization of this platform represents an improvement in outcomes compared to multiport robot-assisted partial nephrectomy (MP-RAPN). To evaluate this, we performed a meta-analysis to compare the perioperative, oncological, and functional outcomes between SP-RAPN and MP-RAPN.
Methods: For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until January 1, 2023. A meta-analysis has been reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and assessing the methodological quality of systematic reviews (AMSTAR) guidelines. The odds ratio (OR) and weighted mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CI).
Results: Of the 374 retrieved abstracts, 29 underwent full-text review, and 8 studies were included in the final analysis, comprising a total cohort of 1007 cases of RAPN (453 SP-RAPN cases and 554 MP-RAPN cases). Compared to MP-RAPN, the SP-RAPN group had a significantly longer ischemia time (MD = 4.6 minutes, 95% CI 2.8 to 6.3, p < 0.001), less estimated blood loss (MD = −12.4 mL, 95% CI −24.6 to −0.3, p = 0.045), higher blood transfusion rate (OR = 2.97, 95% CI 1.33 to 6.65, p = 0.008), and higher postoperative estimated glomerular filtration rate (eGFR) at 6 months (MD = 4.9 mL/min, 95% CI 0.2 to 9.7, p = 0.04). There was no significant difference in other outcomes between the two approaches, including the intraoperative complication, overall postoperative complication, minor postoperative complication (Clavien-Dindo I − II), major postoperative complication (Clavien-Dindo III–V), conversion to radical nephrectomy, pain score on day #1, pain score on discharge, morphine milligram equivalent usage, hospital stay, positive surgical margins, and postoperative eGFR.
Conclusions: SP-RAPN represents an emerging technique using a novel platform. Initial studies have demonstrated that SP-RAPN is a safe and feasible approach to performing partial nephrectomy, although with inferior outcomes for ischemia time and blood transfusion rates. Further studies will be necessary to define the best usage of SP-RAPN within the surgeon's armamentarium.
... Therefore, it is very important to have more reliable methods to measure the blood loss. The methods used to estimate or to measure blood loss are as follows: visual estimation, gravimetric method, direct measurement, photometry, calculation methods, colorimetric analysis, and miscellaneous [6,7]. ...
... Direct measurement of blood loss is a simple and long-established method that is mainly used in the field of obstetrics [6]. A calibrated collection bag with a scale is designed for vaginal deliveries. ...
... The formulas take into account height, weight, body surface area and gender of the patient. All blood loss estimation formulas showed a significant tendency to overestimate blood loss [6]. ...
Background
Blood loss during major abdominal surgery is an essential parameter in the evaluation of strategies aimed at reducing perioperative bleeding. However, blood loss quantification remains unreliable and inaccurate. The aim of this study was to compare several methods of blood loss quantification—visual estimation by surgeon and anesthesiologist, the gravimetric method, the calculation method with spectrophotometric measurement. The spectrophotometric measurement is considered as the most accurate method.
Methods
The study was designed as a prospective observational cohort single-center study. We analyzed 61 patients who underwent elective liver or pancreatic resection. The anesthesiologists’ and surgeons' estimate of blood loss was based on a visual assessment. The gravimetric method was based on weighing the suction canister and surgical drapes before and after use. The basis of calculation method was anthropometric and hematological parameters, we used López-Picado's formula. The spectrophotometric method was based on the spectrophotometric determination of hemoglobin mass in the lost blood. We compared the methods using paired t-test, non-parametric Wilcoxon test and Bland–Altman analysis.
Results
Visual estimation by surgeons and anesthesiologists, gravimetric measurement, and calculation method were significantly different from spectrophotometric measurement at the significance level α = 0.05. All methods overestimated blood loss which was measured by spectrophotometric method. The estimate by surgeons was the closest to the spectrophotometric measurement, difference 68.7 ml (95% confidence interval [CI]: -129.3–-8.2).
Conclusions
We conclude that the estimate of blood loss by surgeons and anesthesiologists, as well as gravimetric method and calculation method are all significantly inaccurate in real surgical setting. We did not confirm the commonly accepted assumption that surgeons underestimate the blood loss.
Trial registration
The study was registered under the title " Blood Loss Quantification During Major Abdominal Surgery" at ClinicalTrials.gov with the registration number NCT05316649. Date of the first registration was 20/3/2022.
... It is important to accurately estimate the amount of blood lost. If necessary, it is necessary to resort to medications to stop bleeding and artificial resuscitation [6]. Evaluating continuous loss of blood is a critical part of postpartum bleeding management. ...
