Blood: Hemostasis, Transfusion, and Alternatives in the Perioperative Period, C. L. Lake and R. A. Moore, eds. New York: Raven Press, 1995, ISBN 0-7817-0267-4, 566 pp, $129.00.
Blood: Hemostasis, Transfusion, and Alternatives in the Perioperative Period is a 27-chapter text written by 44 contributing authors. While the scope of the text is broad, the primary purpose of the text is to provide the clinician with comprehensive information regarding the pathophysiology and perioperative management of congenital and acquired defects of hemostasis. There are a number of textbooks currently available that address the many aspects of hematology and transfusion medicine. This particular text places emphasis on the management of the bleeding patient and, to this end, is applicable to clinicians from a variety of specialties.
The text is divided into five sections. The first two sections address normal hemostasis, disorders of hemostasis, the evaluation of patients with disorders of hemostasis, and pharmacologic manipulation of hemostasis and coagulation. The chapters in these two sections are, for the most part, well written and thorough in their discussions. The accompanying diagrams and illustrations are well formatted and useful to the reader to synthesize the material. This is particularly important in the chapters on disorders of hemostasis and evaluation of hemostasis. The chapters devoted to the pharmacologic manipulation of coagulation and the chapter on the pharmacologic manipulation of hemostasis are concise and yet offer discussion of newer and, in certain instances, controversial management strategies. The chapter on perioperative blood loss lacks direction and the depth of discussion noted in other chapters. The relevant material in this chapter on measurement of blood loss could have been incorporated into a related chapter. Furthermore, the discussion of blood loss in four specific areas is needless duplication of information that is covered in much greater detail in other chapters of the text.
The third section addresses transfusion therapy to include blood component therapy, the medicolegal aspects of transfusion therapy, and infectious risks and other complications associated with transfusions. The chapters in this section devoted to infectious risks and complications associated with transfusion therapy are comprehensive and provide an excellent review. The chapter on blood component therapy is also well written. However, a more complete discussion of the current philosophy regarding indications for blood component therapy in patients undergoing operative procedures would have been valuable. The chapter on the medicolegal aspects of transfusion therapy is presented as a broad overview. Absent in this overview is a discussion of the specific elements necessary to provide the patient informed consent as it relates to the administration of blood or blood components.
The fourth and fifth sections are devoted to alternatives to transfusion therapy and special concerns. The section on special concerns covers coagulation changes associated with massive transfusion and specific perioperative coagulopathies to include the obstetric patient, the neonate, cardiac surgery, and transplantation. The chapters in both sections consistently provide useful and thoughtful review of the material as well as up-to-date references for readers who desire further study. While recent discoveries and new concepts are presented, the relevance of the information in the clinical setting is clearly outlined. The chapters on hemodilution, blood substitutes, and specific coagulopathies related to the neonate and to cardiac surgery deserve special praise. The chapter on evaluation and management of anemia, while providing discussion of specific disease entities, lacks discussion of anemia resulting from acute blood loss.
In summary, this text provides a review of hemostasis and disorders of hemostasis with a focus on the perioperative management of the bleeding patient. While certain chapters present a limited perspective, most chapters are complete and meet the objective of providing the reader with knowledge and tools to guide decision making as it relates to hemostasis and transfusion therapy. With multiple authors, the organization of material within chapters is somewhat variable. In addition, repetition of information is noted, for example, on discussions pertaining to the coagulation cascade, perioperative coagulopathy associated with cardiac surgery, the obstetric patient, and complications of transfusion therapy. In spite of this, the text is recommended as an extensive, clinically relevant resource for any specialist who must manage patients with preexisting or acquired coagulopathies or patients who require blood, blood products, or their alternatives.
Kirk T. Benson, MD
Department of Anesthesiology
University of Kansas Medical Center, Kansas City, KS 66160-7415