Inflammation, Hemostasis, An Issue of Hematology/Oncology Clinics

This issue reviews inflammation, hemostasis, and blood conservation strategies in patients following surgery, trauma, or complex injuries, and focuses on coagulopathies due to multiple factors including hemorrhage, surgical injuries, or drugs that affect the hemostatic system. Hemostasis and therapeutic approaches for bleeding and medical patients are discussed, including important aspects of thrombin signaling, protease activated receptor involvement, platelet dysfunction, and clot stabilization.The increasing problem of heparin-induced thrombocytopenia as a prothrombotic disease is discussed. Different approaches to reduce bleeding and transfusion requirements in critically ill patients are included based on either preventing or reversing the defects associated with coagulopathies. Blood conservation and the risks of transfusions are reviewed, including an update on transfusion-related acute lung injury.  Pharmacologic approaches, an important aspect of blood conservation and are reviewed, including the recent New England Journal of Medicine controversy about aprotinin. Strategies involved in blood conservation in critically ill patients is included with focus on pharmacologic blood-sparing studies. Multiple pharmacologic approaches to reducing and treating bleeding are reviewed. Current and future pharmacologic approaches to attenuating hemostatic system activation, inflammation, and bleeding, and the potential need for allogeneic blood administration are important focuses of this issue.