Background and Goal of Study: 
The top department which consumed more than 10 units of blood products per patient in Japan is cardiovascular surgery1) and therefore, we anaesthesiologists have sometimes experienced shortage of transfusion stock post operatively in the intensive care units (ICU).  To avoid these situations, we investigated which measurements including complete blood count (CBC), coagulation test, and rotation thromboelastmetry (ROTEM) were useful at the end of surgery to predict the patients who needed transfusion in the ICU. 
Materials and methods:	
Patients scheduled cardiac surgery with cardiopulmonary bypass (CPB) were assessed for eligibility. The criteria of peri-operative blood transfusion were indicated below, such as hemoglobin >9~10mg/dl, fibrinogen > 150~200mg/dl, platelet count > 50,000~100,000 /μl. The patients of high risk groups, such as total arch replacement, re-do operation, or their CPB time > 3h were targeted to the upper limit of these criteria2) based on the measurement during operation. The heparin dose during CPB was administered 300~400U/kg to target activated clotting time (ACT)>450sec and reversed by protamine sulfate 60~100% dose of heparin. The hemostatic therapies were such as concentrated red cells, fresh frozen plasma, and platelet concentration. We collected the blood samples at the end of surgery and measured CBC, coagulation test, and ROTEM and investigated which measurements were significantly different between the patients with or without transfusion in the ICU. 
Results and Discussion: 
Sixty patients were enrolled in the study and we found the significance for Hemoglobin (Hb), APTT, EXTEM A10, EXTEM-FIBTEM A10, and Clotting Elasticity (CE) indicated at Table below.  CE is said to be more accurate for platelet aggregation calculated by the formula below (100×EXTEM)/(100-EXTEM)− (100×FIBTEM)/(100-FIBTEM)3). 
Conclusion: 
Hemostatic therapy based on POC testing are useful during operation4,5). but also in the ICU. APTT was also useful because it is more sensitive for residual heparin or heparin rebound than ACT. 
References:
1.	Japanese Journal of Transfusion and Cell Therapy, 2015; 61：409-415
2.	http://www.mhlw.go.jp/new-info/kobetu/iyaku/kenketsugo/5tekisei3b.html
3.	Anesth Analg 2015;121:868-78
4.	Anesthesiology. 2011 Dec;115(6):1179-912. 
5.	Anesthesiology. 2012 Sep;117(3):531-47


17 / Which blood measurements were lower for post-operative cardiovascular patients who required transfusion in the intensive care unit?