AIM:To investigate whether fresh frozen plasma (FFP) transfusion affects outcomes following hepatic resection for hepatocellular carcinoma (HCC) in terms of liver function,postoperative complications and cancer progno...AIM:To investigate whether fresh frozen plasma (FFP) transfusion affects outcomes following hepatic resection for hepatocellular carcinoma (HCC) in terms of liver function,postoperative complications and cancer prognosis.METHODS:We retrospectively compared the incidence of postoperative complications between 204 patients who underwent hepatectomy for HCC with routine FFP transfusion in an early period (1983-1993,Group A) and 293 with necessity for FFP transfusion during a later period (1998-2006,Group B),and also between two subgroups of Group B [22 patients with FFP transfusion (Group B1) and 275 patients without FFP transfusion (Group B2)].Additionally,only in limited patients in Group B1 and Group B2 with intraoperative blood loss≥ 2000 mL (Group B1 ≥ 2000 mL and Group B2 ≥ 2000 mL),postoperative complications,liver function tests,and cancer prognosis were compared.RESULTS:No mortality was registered in Group B,compared to 8 patients (3.9%) of Group A.The incidence of morbidity in Group B2 [23.2% (64/275)] was not significantly different from Group B1 [40.9% (9/22)] and Group A [27.0% (55/204)].The incidence of complications and postoperative liver function tests were comparable between Group B1 ≥ 2000 mL vs Group B2 ≥ 2000 mL.Postoperative prognosis did not correlate with administration of FFP,but with tumor-related factors.CONCLUSION:The outcome of hepatectomy for HCC is not influenced by FFP transfusion.We suggest FFP transfusion be abandoned in patients who undergo hepatectomy for HCC.展开更多
Objective To determine the safety and efficacy of fresh frozen plasma （FFP） iniusion for the treat- ment of hereditary angioedema （FIAE）. Methods The medical records of patients with HAE admitted to Peking Union ...Objective To determine the safety and efficacy of fresh frozen plasma （FFP） iniusion for the treat- ment of hereditary angioedema （FIAE）. Methods The medical records of patients with HAE admitted to Peking Union Medical College Fiospital who had received FFP infusion during 2004 and 2010 were reviewed and PubMed database iFom 1966 to the present were searched using the following key words： hereditary angioedema and fresh frozen plasma. The patient＇s age, sex, body location of HAE attacks, the dose of FFP infusion, time of beginning to improvenaent, time to complete remission, complication, C 1 inhibitor activity, and outcome were analyzed. Results A total of 13 enrolled patients （7 male and 6 female） received 16 times of FFP infusion, in- cluding 2 patients undergoing FFP infusion in Peking Union Medical College Hospital and 11 patients re- ported in the literature. The mean dosage of FFP infusion was 586±337 mL. Two cases suffered from wors- ening abdominal pain and one case experienced skin rash. Only I patient had no improvement in symptom owing to transfusion related reaction. There was a definite improvement in symptom 49± 19 minutes after beginning FFP infusion. The remission time decreased from 61.7±27.0 hours to 3.3 （2.0, 12.0） hours after FFP infusion. FFP infusion was effective for both type I and type Ⅱ HAE. Conclusion FFP seems to be safe and effective for acute attacks of HAE.展开更多
HEREDITARY angioedema （HAE） is an autosomal dominant inherited condition which was initially described by Osier in 1888.1 Patients with HAE can develop rapid subcutaneous or submucosal edema involving the hands, fee...HEREDITARY angioedema （HAE） is an autosomal dominant inherited condition which was initially described by Osier in 1888.1 Patients with HAE can develop rapid subcutaneous or submucosal edema involving the hands, feet, limbs, face, intestinal tract, even larynx and trachea. The mortality of an acute attack of HAE without treatment was reported as high as 30%.2 HAE is caused by the deficiency of Cl esterase inhibitor （CIINH） which results in episodes of edema in parts of the human body,展开更多
Hump-nosed viper bite is the commonest venomous snakebite in Sri Lanka. Acute kidney injury (AKI) in association with coagulopathy is an important cause of mortality. Immunomodulating effects of fresh frozen plasma (F...Hump-nosed viper bite is the commonest venomous snakebite in Sri Lanka. Acute kidney injury (AKI) in association with coagulopathy is an important cause of mortality. Immunomodulating effects of fresh frozen plasma (FFP) could block the nephrotoxic effects of venom;and by replenishing depleted clotting factors resulting from venom induced consumption coagulopathy could offer an additional benefit in offsetting renal injury triggered by haematological disturbances. In a non-randomised observational study carried out from 2005 to 2008 in adults at the National hospital of Sri Lanka, the mean time for resolution of coagulopathy among 42 patients treated with FFP at the inception of coagulopathy was 4.7 hours compared to 18 patients treated with isotonic Saline among whom the mean time for normalisation of coagulopathy was 6.2 hours. None of these 60 patients developed acute renal failure. A separate cohort of 32 patients with coagulopathy after hump-nosed viper bite who had not received FFP during this study period developed acute renal failure and required haemodialysis. In the absence of safe and effective antivenom for hump-nosed viper in Sri Lanka, FFP may be a therapeutic option. FFP if given early to selected patients at inception of coagulopathy may prevent AKI and serve to save lives after hump-nosed viper bites.展开更多
Transfusions of blood products are common in medical practice and can be lifesaving in certain situations. Potentially life threatening reactions could occur and physicians should be alerted. Here we describe a case o...Transfusions of blood products are common in medical practice and can be lifesaving in certain situations. Potentially life threatening reactions could occur and physicians should be alerted. Here we describe a case of thrombocytopenia that was induced by transfusion of fresh frozen plasma (FFP). A 52 years old male presented to the emergency department after two episodes of hematochezia that resolved spontaneously. Since he was anticoagulated for atrial fibrillation he was given a unit of FFP to reverse a slightly elevated INR. Within 6 hours from the administration of the FFP he developed an acute decrease only in his platelet count. He was managed conservatively and his thrombocytopenia started resolving gradually. After excluding other causes the potential diagnosis was fresh frozen plasma induced thrombocytopenia. The pathophysiologic mechanism is postulated to be immune mediated by passive transfer of antibodyies from the donor to the recipient. The antibodies that are described in the literature are anti-HPA-1a and anti-CD-36. We reported the event to the American Red Cross. Interestingly a male was the donor of the plasma while in all cases in the literature the donors are females with a prior history of pregnancy. Therefore this is the first reported case of a male blood donor whose blood product caused immune mediated thrombocytopenia post transfusion.展开更多
Hemodynamic instability plays a major role in the pathogenesis of systemic inflammation, tissuehypoxia, and multiple-organ dysfunction syndrome associated with severe acute pancreatitis （SAP）. Aggressive fluid repla...Hemodynamic instability plays a major role in the pathogenesis of systemic inflammation, tissuehypoxia, and multiple-organ dysfunction syndrome associated with severe acute pancreatitis （SAP）. Aggressive fluid replacement is one of the key interventions for the hemodynamic support in severe acute pancreatitis.~Although the need for fluid resuscitation in severe pancreatitis is well established, the goals and components of this treatment are still a matter of debate. We used resuscitation strategies according to early goal- directed therapy （EGDT）; we measured the effects of these volume resuscitation on clinical outcomes such as organ function and mortality. Because frozen plasma is cheaper and more easily acquired than albumin for patients, we hypothesized that fluid resuscitation with frozen plasma according to EGDT would be associated with reduced incidence of organ failure and mortality as compared with individuals resuscitated with normal crystalloid and plasma substitute volume resuscitation.展开更多
Warfarin is a commonly used oral anticoagulant.Patients with artificial valve replacement,atrial fibrillation,pulmonary embolism,deep vein thrombosis,and other diseases require long-term anticoagulant oral treatment w...Warfarin is a commonly used oral anticoagulant.Patients with artificial valve replacement,atrial fibrillation,pulmonary embolism,deep vein thrombosis,and other diseases require long-term anticoagulant oral treatment with warfarin.As warfarin exhibits prompt action with long maintenance time,it has become a key drug for the treatment of patients at risk of developing thrombosis or thromboembolism.Warfarin is a bican coumarin anticoagulant,that exhibits competitive action against vitamin K as its mechanism of action,thereby inhibiting the synthesis of coagulation factors—predominantly the vitamin K-dependent coagulation factors II,VII,IX,and X—in hepatocytes.Long-term warfarin is known to significantly increase the risk of organ bleeding in some patients,while some patients may need to reverse the anticoagulation effect.For instance,patients scheduled for emergency or invasive surgery may require rapid anticoagulation reversal.During such medical circumstances,fresh frozen plasma(FFP)is clinically used for the reversal of excess warfarin-associated anticoagulation,as it contains all the coagulation factors that can alleviate the abnormal blood anticoagulation status in such patients.Accordingly,this article aims to perform an in-depth review of relevant literature on the reversal of warfarin with FFP,and insightful deliberation of the application and efficacy of this clinical intervention.展开更多
Objective: The objective of this study was to analyse the reversibility of the anticoagulant effect of warfarin by comparing prothrombin complex concentrate (PCC) versus frozen fresh plasma (FFP) in cardiology patient...Objective: The objective of this study was to analyse the reversibility of the anticoagulant effect of warfarin by comparing prothrombin complex concentrate (PCC) versus frozen fresh plasma (FFP) in cardiology patients with serious warfarin intoxication. Methods: This was an observational and retrospective study comprising 67 patients (18 in group I [PCC] and 49 in group II [FFP]). The primary endpoint was the reversal of anticoagulant effect of warfarin after 2 and 24 hours of PCC or FFP administration. Comparisons between the groups were made using T-test and Q-square. Multivariate analyses were conducted using logistic regression, and the results were considered significant when p Results: The medium dose used was 27.6 UI/kg of PCC and 14.5 ml/kg of FFP. Significant differences were observed between groups I and II in the INR reversibility measurements after 2 hours (33.3% vs. 6.1%, p = 0.001) and 24 hours (38.9% vs. 12.2%, p = 0.009) as well as in the occurrence of pulmonary edema (5.6% vs. 42.9%, OR = 11.10, p = 0.04). The AUC for PCC was 0.891 (CI 95% [0.72 - 1.0]), and for FFP, it was 0.291 (CI 95% [0.09 - 0.49]). Conclusions: PCC is better than FFP treatment in reversing the warfarin intoxication after 2 and 24 hours of administration. Furthermore, PCC showed lower pulmonary edema in cardiology patients.展开更多
文摘AIM:To investigate whether fresh frozen plasma (FFP) transfusion affects outcomes following hepatic resection for hepatocellular carcinoma (HCC) in terms of liver function,postoperative complications and cancer prognosis.METHODS:We retrospectively compared the incidence of postoperative complications between 204 patients who underwent hepatectomy for HCC with routine FFP transfusion in an early period (1983-1993,Group A) and 293 with necessity for FFP transfusion during a later period (1998-2006,Group B),and also between two subgroups of Group B [22 patients with FFP transfusion (Group B1) and 275 patients without FFP transfusion (Group B2)].Additionally,only in limited patients in Group B1 and Group B2 with intraoperative blood loss≥ 2000 mL (Group B1 ≥ 2000 mL and Group B2 ≥ 2000 mL),postoperative complications,liver function tests,and cancer prognosis were compared.RESULTS:No mortality was registered in Group B,compared to 8 patients (3.9%) of Group A.The incidence of morbidity in Group B2 [23.2% (64/275)] was not significantly different from Group B1 [40.9% (9/22)] and Group A [27.0% (55/204)].The incidence of complications and postoperative liver function tests were comparable between Group B1 ≥ 2000 mL vs Group B2 ≥ 2000 mL.Postoperative prognosis did not correlate with administration of FFP,but with tumor-related factors.CONCLUSION:The outcome of hepatectomy for HCC is not influenced by FFP transfusion.We suggest FFP transfusion be abandoned in patients who undergo hepatectomy for HCC.
文摘Objective To determine the safety and efficacy of fresh frozen plasma （FFP） iniusion for the treat- ment of hereditary angioedema （FIAE）. Methods The medical records of patients with HAE admitted to Peking Union Medical College Fiospital who had received FFP infusion during 2004 and 2010 were reviewed and PubMed database iFom 1966 to the present were searched using the following key words： hereditary angioedema and fresh frozen plasma. The patient＇s age, sex, body location of HAE attacks, the dose of FFP infusion, time of beginning to improvenaent, time to complete remission, complication, C 1 inhibitor activity, and outcome were analyzed. Results A total of 13 enrolled patients （7 male and 6 female） received 16 times of FFP infusion, in- cluding 2 patients undergoing FFP infusion in Peking Union Medical College Hospital and 11 patients re- ported in the literature. The mean dosage of FFP infusion was 586±337 mL. Two cases suffered from wors- ening abdominal pain and one case experienced skin rash. Only I patient had no improvement in symptom owing to transfusion related reaction. There was a definite improvement in symptom 49± 19 minutes after beginning FFP infusion. The remission time decreased from 61.7±27.0 hours to 3.3 （2.0, 12.0） hours after FFP infusion. FFP infusion was effective for both type I and type Ⅱ HAE. Conclusion FFP seems to be safe and effective for acute attacks of HAE.
文摘HEREDITARY angioedema （HAE） is an autosomal dominant inherited condition which was initially described by Osier in 1888.1 Patients with HAE can develop rapid subcutaneous or submucosal edema involving the hands, feet, limbs, face, intestinal tract, even larynx and trachea. The mortality of an acute attack of HAE without treatment was reported as high as 30%.2 HAE is caused by the deficiency of Cl esterase inhibitor （CIINH） which results in episodes of edema in parts of the human body,
文摘Hump-nosed viper bite is the commonest venomous snakebite in Sri Lanka. Acute kidney injury (AKI) in association with coagulopathy is an important cause of mortality. Immunomodulating effects of fresh frozen plasma (FFP) could block the nephrotoxic effects of venom;and by replenishing depleted clotting factors resulting from venom induced consumption coagulopathy could offer an additional benefit in offsetting renal injury triggered by haematological disturbances. In a non-randomised observational study carried out from 2005 to 2008 in adults at the National hospital of Sri Lanka, the mean time for resolution of coagulopathy among 42 patients treated with FFP at the inception of coagulopathy was 4.7 hours compared to 18 patients treated with isotonic Saline among whom the mean time for normalisation of coagulopathy was 6.2 hours. None of these 60 patients developed acute renal failure. A separate cohort of 32 patients with coagulopathy after hump-nosed viper bite who had not received FFP during this study period developed acute renal failure and required haemodialysis. In the absence of safe and effective antivenom for hump-nosed viper in Sri Lanka, FFP may be a therapeutic option. FFP if given early to selected patients at inception of coagulopathy may prevent AKI and serve to save lives after hump-nosed viper bites.
文摘Transfusions of blood products are common in medical practice and can be lifesaving in certain situations. Potentially life threatening reactions could occur and physicians should be alerted. Here we describe a case of thrombocytopenia that was induced by transfusion of fresh frozen plasma (FFP). A 52 years old male presented to the emergency department after two episodes of hematochezia that resolved spontaneously. Since he was anticoagulated for atrial fibrillation he was given a unit of FFP to reverse a slightly elevated INR. Within 6 hours from the administration of the FFP he developed an acute decrease only in his platelet count. He was managed conservatively and his thrombocytopenia started resolving gradually. After excluding other causes the potential diagnosis was fresh frozen plasma induced thrombocytopenia. The pathophysiologic mechanism is postulated to be immune mediated by passive transfer of antibodyies from the donor to the recipient. The antibodies that are described in the literature are anti-HPA-1a and anti-CD-36. We reported the event to the American Red Cross. Interestingly a male was the donor of the plasma while in all cases in the literature the donors are females with a prior history of pregnancy. Therefore this is the first reported case of a male blood donor whose blood product caused immune mediated thrombocytopenia post transfusion.
文摘Hemodynamic instability plays a major role in the pathogenesis of systemic inflammation, tissuehypoxia, and multiple-organ dysfunction syndrome associated with severe acute pancreatitis （SAP）. Aggressive fluid replacement is one of the key interventions for the hemodynamic support in severe acute pancreatitis.~Although the need for fluid resuscitation in severe pancreatitis is well established, the goals and components of this treatment are still a matter of debate. We used resuscitation strategies according to early goal- directed therapy （EGDT）; we measured the effects of these volume resuscitation on clinical outcomes such as organ function and mortality. Because frozen plasma is cheaper and more easily acquired than albumin for patients, we hypothesized that fluid resuscitation with frozen plasma according to EGDT would be associated with reduced incidence of organ failure and mortality as compared with individuals resuscitated with normal crystalloid and plasma substitute volume resuscitation.
文摘Warfarin is a commonly used oral anticoagulant.Patients with artificial valve replacement,atrial fibrillation,pulmonary embolism,deep vein thrombosis,and other diseases require long-term anticoagulant oral treatment with warfarin.As warfarin exhibits prompt action with long maintenance time,it has become a key drug for the treatment of patients at risk of developing thrombosis or thromboembolism.Warfarin is a bican coumarin anticoagulant,that exhibits competitive action against vitamin K as its mechanism of action,thereby inhibiting the synthesis of coagulation factors—predominantly the vitamin K-dependent coagulation factors II,VII,IX,and X—in hepatocytes.Long-term warfarin is known to significantly increase the risk of organ bleeding in some patients,while some patients may need to reverse the anticoagulation effect.For instance,patients scheduled for emergency or invasive surgery may require rapid anticoagulation reversal.During such medical circumstances,fresh frozen plasma(FFP)is clinically used for the reversal of excess warfarin-associated anticoagulation,as it contains all the coagulation factors that can alleviate the abnormal blood anticoagulation status in such patients.Accordingly,this article aims to perform an in-depth review of relevant literature on the reversal of warfarin with FFP,and insightful deliberation of the application and efficacy of this clinical intervention.
文摘Objective: The objective of this study was to analyse the reversibility of the anticoagulant effect of warfarin by comparing prothrombin complex concentrate (PCC) versus frozen fresh plasma (FFP) in cardiology patients with serious warfarin intoxication. Methods: This was an observational and retrospective study comprising 67 patients (18 in group I [PCC] and 49 in group II [FFP]). The primary endpoint was the reversal of anticoagulant effect of warfarin after 2 and 24 hours of PCC or FFP administration. Comparisons between the groups were made using T-test and Q-square. Multivariate analyses were conducted using logistic regression, and the results were considered significant when p Results: The medium dose used was 27.6 UI/kg of PCC and 14.5 ml/kg of FFP. Significant differences were observed between groups I and II in the INR reversibility measurements after 2 hours (33.3% vs. 6.1%, p = 0.001) and 24 hours (38.9% vs. 12.2%, p = 0.009) as well as in the occurrence of pulmonary edema (5.6% vs. 42.9%, OR = 11.10, p = 0.04). The AUC for PCC was 0.891 (CI 95% [0.72 - 1.0]), and for FFP, it was 0.291 (CI 95% [0.09 - 0.49]). Conclusions: PCC is better than FFP treatment in reversing the warfarin intoxication after 2 and 24 hours of administration. Furthermore, PCC showed lower pulmonary edema in cardiology patients.
