Dipak Kholwadwala MD Pediatric Cardiology www.DrMDK.com
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Interviewer: You took a Cardio-Vascular Surgery, is that correct? Doctor: Yes, I do. Interviewer: But you specialized in a very unit care, you try to use no or very low blood many times, is that true? Doctor: Yes, these are in our global sort of plan and have the best outcomes for a people having a heart surgery in particular. My area of specialty is pediatric heart surgery or congenital heart surgery. And we found that better outcomes can also be related to such strategies that avoid this of blood or minimize this blood and blood products during and after heart surgery. Interviewer: How is that possible, because you have to work it up with a very bloody field many times? Doctor: Traditionally, heart surgery has been associated with blood transfusion and early in the years with a lot of blood transfusion; in fact a lot of the complications that resulted from heart surgery were actually a direct result of massive blood transfusions. Over the years, the need for that is actually decreased and now we have evolved with certain methodologies both in the operating room, before surgery and after surgery whereby we can actually minimize and in fact in many cases completely avoid transfusion of blood or blood products all together. Interviewer: Have you ever force to procure a heart lung machine? Doctor: Yes, so typically when we give open heart surgery as it is called there, when we do an operation on the inside of the heart we do use a heart lung machine or a cardiopulmonary bypass. And as the part of that we typically are able to use other fluids, other than blood these days whereby we can actually do the surgery without blood transfusion, one of the things that we will do before surgery, if we start out with a good blood level of what we call hemoglobin. In that case, the chance of blood transfusion is minimized and to achieve a low incidence of blood transfusion we actually will often build up the blood count in some people and in some children we can actually give a medication Erythropoietin to actually build up the blood count before surgery. Interviewer: Does it mean that we actually make a wrong, don’t we? Doctor: Yes we do. Interviewer: And you are giving a lot more than you know that we will make, is that correct? Doctor: So, Erythropoietin is something that we normally make on our own, that is absolutely correct. And it is now manufactured whereby can actually give people additional larger doses of Erythropoietin. Now, that is not to say that everybody needs this medication. t is actually available as an injection; many people have a good abnormal blood count to start with. There are some children for instance who will have a low blood count and to achieve the ability to do the surgery without giving any blood transfusion, it is actually beneficial that they receive this. So, apart of the strategy is actually to build up the blood, the actual blood count before heart surgery then we actually do a number of things during heart surgery to minimize the chance for blood transfusion. We actually miniaturize a heart lung machine component to the size of our miniature patients or pediatric patients so that we actually do not need to use the amount of volume that we have traditionally used to do heart surgery in little babies. By doing so, the chance of blood transfusion is less. We use certain other medications during heart surgery which actually minimize the amount of bleeding during and after heart surgery and these medications also reduce the, what we called inflammatory effects of the heart lung machine. Interviewer: So, if you do not have to give a kid transfusion, there are some real benefits. One, you do not worry about some diseases that transfusion carry with them, is that true? Doctor: That is true, there is a small but definite risk of transmission of diseases through blood transfusion very specifically. There is virus transmissions including Hepatitis and HIV during, given the current practices of blood banking t
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