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A Clinically practical way to estimate surgical blood loss

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A Clinically practical way to estimate surgical blood loss
Kristen Hughes MD, Y Connie Chang MD, Joseph Sedrak MD, Abel Torres MD JD
Dermatology Online Journal 13 (4): 17

Arriving at an accurate measure of blood loss is a challenge many practitioners encounter after skin surgery. To date, there has not been a clinically practical way to gauge this figure. Weighing sponges, gauze pads, measuring drainage containers, or mere guesstimation are the most common methods utilized. Unfortunately, the former methods are a nuisance, and the latter is typically unreliable [1, 2]. This is true even for major surgical procedures when blood loss may posse a threat to survival [3]. This simple study quantifies the absorption capacity of gauze pads, a material widely used in dermatologic surgery. Awareness of this value allows for a more rapid and better estimation of blood loss.


Figure 1
Figure 1: The 2x2 gauze pads completely absorbed a maximum of 4.5 mL of normal saline. At 5.0 mL, super-saturation was observed. Excess normal saline at the bottom of the sterile container stained purple for visibility.

The absorption capacity for 2x2 inches and 4x4 inches gauze pads were explored as these are the most commonly utilized materials during surgery. The 2x2 sponges used in this study were manufactured by Kendall Curity, 12 Ply, USP Type VII. The 4x4 sponges were manufactured by McKesson, 4 Ply non-woven sponges. The same technique was applied to both sizes. Sterile containers, each holding one gauze pad, were filled with sequentially increasing amounts of saline ranging from 1-5 mL, in 0.5 mL increments for the 2 x 2 gauze pads, and 6-13 mL, in 1 mL increments for the 4x4 gauzes. Saturation was defined as the point at which no dry gauze was visible or felt. The end point was achieved when excess fluid remained unabsorbed at the bottom of the container, a sign of super-saturation (Fig. 1). The 2x2 gauze appeared completely moist from 2-4.5 mL with supersaturation noted at 5 mL (maximum absorption capacity of 4.5 cc), while the 4x4 gauze pads appeared completely moist from 8-12 mL with supersaturation at 13 mL (maximum absorption at 12 mL). The average carrying capacity was defined as the average between the initial saturation point and the maximum saturation point.

From this experiment it can be concluded that a completely soaked 2x2 gauze has an average carrying capacity of 3.25 cc ± 1.25 cc and that a 4x4 sponge has an average carrying capacity of 10 cc ± 2 cc. The limitations of this experiment include intraobserver subjectivity, limitation of results to only the tested brands of gauze, and the fact that normal saline was substituted in place of blood. Blood has a greater viscosity than saline and has clotting factors, which may allow for a greater gauze absorption capacity. Nevertheless, knowing the number of gauze pads used in surgery and awareness of the individual sponge absorption capacity provides a clinically practical and rapid method to estimate blood loss.


1. Kolb KS, Day T, McCall WG. Accuracy of blood loss termination by health care professionals. Clin Forum Nurse Anesth. 1999;10:170-173.

2. Razvi K, Chua S, Arulkumaran S, Ratnam SS. A comparison between visual estimation and laboratory determination of blood loss during the third stage of labor. Aust NZ Obstet Gynecol.

3. Larsson C, Saltvedt S, Wiklund , Pahlen S, Andolf E. Estimation of blood loss after cesarean section and vaginal delivery has low validity with a tendency to exaggeration. Acta Obstetricia et Gynecologica. 2006;85;1448-14452.

© 2007 Dermatology Online Journal