ABSTRACT
ABSTRACT Background: Currently the treatment of choice for critical liver failure is liver transplantation. Liver failure is treated conservatively until a matching liver donor becomes available. The therapeutic plasma exchange (TPE) plays an important role as a bridge to transplantation by removing accumulated toxins from patient plasma, as well as restoring the coagulation profile. Method: This was a retrospective study on critically ill liver disease patients who underwent TPE from January 2012 to September 2015. The data were collected for the analyses of coagulation parameters, liver function tests, renal function tests, model for end-stage liver disease (MELD) scores, mortality, and hospital stay. Results: In the study duration, a total of 45 patients with critical liver disease underwent therapeutic plasma exchange. The TPE resulted in a statistically significant reduction in the bilirubin level, aspartate aminotransferase (AST), alanine aminotransferase (ALT), prothrombin time (PT), international normalized ratio (INR), serum ferritin level and MELD scores. Higher MELD scores in both pre- and post-TPE were associated with higher mortality during the hospital stay. Conclusion: The TPE is safe and well-tolerated, and it improves coagulation profile and liver function tests in critically ill liver disease patients, but the overall survival remains low.
Subject(s)
Humans , Plasma , Liver Failure, AcuteABSTRACT
Introduction: In quality management system for processimprovement and better inventory management, a performancemonitoring tool is critical in the blood bank to improvequality and discard rate of blood component is one of theessential elements. This study was designed to analyse bloodcomponent discard and their reason in a newly developedinstitute and blood bank setup.Material and Methods: It was a retrospective observationalstudy from May 2018 to March 2019. During the study perioddata was captured and analysed for component preparationand discarded individually and cumulatively. Major reasonswere analysed for blood component discard.Results: Total number of blood component discard observedwere 1714 out of which 368 red cell component (21.4%);1139 Platelet component (66.4%), 210 fresh frozen plasmas(11.7%); 6 cryoprecipitate and cryo poor plasma respectively(0.6%) were discarded. Major reasons for discard of bloodcomponent were expiry, TTI reactivity, leakage, and red cellcontaminations.Conclusion: The current study reflects very high discardrate compared to other published studies and recommendthe following the necessary policies and supervision forreduction of blood component discard are need based changeand production of blood components and better inventorymanagement in new hospital based setup and followingstandard procedure for manufacturing, storage and transfer ofblood components.