Perioperative blood management of a patient with coagulation factor Ⅴ deficiency and literature review / 中国输血杂志

【Objective】 To explore the perioperative blood management in patients with pancreatic pseudocyst combiend with coagulation factor Ⅴ(FⅤ) deficiency. 【Methods】 Preoperative: In order to determine the effect of cryoprecipitated antihemophilic factor and fresh frozen plasma (FFP) on the elevation level of factor Ⅴ, we alternately infused cryoprecipitate and FFP in the resting state. TEG, coagulation function and coagulation factor activity were monitored before and 1 h, 24 h and 48 h after infusion, and intraoperative and postoperative blood transfusion strategies were formulated. FFP 600 mL and cryoprecipitate 10 U were supplemented preoperatively. Intraoperative: The operation procedure was performed for 7 hours with an infusion of 600 mL FFP without significant bleeding. Postoperative: FFP was infused. 【Results】 Preoperative: The coagulation factor Ⅴ activity on pre-operation was 1.9% and 1.8%. After alternating infusion cryoprecipitate 10 U and FFP 1 200 mL, the FⅤactivity increased to 5.1% and 6.0%, respectively. There was no significant difference in TEG parameters, PT and ATPP results were decreased to varying degrees. Intraoperative: The operation was successful without obvious bleeding. Postoperative: FFP 500 mL was infused 2 h after operation, and FFP 250-500 mL was injected daily from 1 to 7 days after surgery. No significant bleeding was observed in the wound, the results of TEG, PT, APTT and hemoglobin (Hb) did not change significantly compared with those before surgery. The patient was discharged successfully 12 days after surgery. The genetic test results showed that he had inherited coagulation factor Ⅴ deficiency, which was a compound heterozygous variation. 【Conclusion】 Perioperative blood management in patients with FⅤ deficiency combined with surgical disease, requiring pre-transfusion evaluation and post-transfusion evaluation in combination with laboratory investigations and clinical manifestations, cryoprecipitate and fresh frozen plasma can be effective in supplementing coagulation factors. The TEG seems to be better than the Seven items of coagulation function in judging the clotting status of patients with FⅤ deficiency.

Hereditary angioedema caused by C1-esterase inhibitor deficiency: a case report with literature-based analysis

Hereditary angioedema (HAE) caused by C1-esterase inhibitor deficiency is an autosomal-dominant disease caused by a mutation in the C1-inhibitor gene. It is a rare disease that is often worsened during pregnancy and childbirth. HAE, though uncommon but if untreated it may lead to maternal death.  The case report presents the successful management of a 24 years old, G2P1, with hereditary angioedema caused by C1-esterase inhibitor deficiency. This patient was managed with a multidisciplinary approach by an obstetrician, an immunologist, an anaesthesiologist and a pediatrician. She had an uneventful antenatal period, labor was induced. She had precipitate delivery and soon after delivery had a flare up of the disease. It was successfully managed with fresh frozen plasma and close observation.

Normalisation of the International Normalised Ratio (INR) Prior to Interventional Procedure: Is it Necessary?

@#Introduction: The fresh frozen plasma (FFP) is frequently prescribed either for therapeutic or prophylactic transfusion. The international normalised ratio (INR) value of 1.50 and above is frequently reported to be a transfusion trigger for FFP prior to interventional procedure. This study aimed to evaluate the efficacy of prophylactic FFP transfusion in normalising the INR and to determine the post-transfusion outcomes. Methods: A prospective cross-sectional study involved 81 patients who received prophylactic FFP transfusion over a period of three months. All demographic, clinical data and outcomes of FFP transfusion were captured and filled in the research proforma. Results: The proportion of patients achieved posttransfusion INR below 1.51 was 30.30% (n=27). The majority of patients underwent the interventional procedures with posttransfusion INR > 1.50 (n=52) without experiencing any bleeding episodes. Overall, FFP transfusion resulted in significant median INR difference from 1.89 (IQR, 0.53) to 1.60 (IQR, 0.25); p< 0.001. The greater median INR difference was observed in group with pretransfusion INR > 2.00 and who received FFP doses between 10.00 to 20.00 ml kg-1 (p < 0.001). The INR difference showed the significant, positive correlation with pretransfusion INR values (rs= 0.83, p < 0.001) and FFP doses (rs= 0.72, p< 0.001). Conclusions: The interventional procedures were safely carried out despite abnormal posttransfusion INR. The prophylactic FFP transfusions could be avoided in patients with mild coagulopathy (INR 1.50 - 2.00) prior interventional procedures.

A Case Report of Transfusion-Related Acute Lung Injury Induced in the Patient with HLA Antibody after Fresh Frozen Plasma Transfusion / 대한수혈학회지

Development of transfusion-related acute lung injury (TRALI), a non-cardiogenic pulmonary edema, after blood transfusion, is a rare but potentially leading cause of mortality from blood transfusion. We report on a case of TRALI in a 51-year male with acute calculous cholecystitis and liver cirrhosis. As preoperative treatment, he was given ten units of fresh frozen plasma (FFP) for 3 days before the operation. During the transfusion of the 10th unit of FFP, he experienced a sudden onset of hemoptysis, tachypnea, tachycardia, and cyanosis. Bilateral pulmonary infiltration not observed on the chest X-ray at the visit was newly developed. There was no evidence of volume overload but severe hypoxemia. Blood transfusion was stopped and he recovered fully after 8 days of oxygen therapy through a nasal cannula. Although HLA and HNA antibodies were not detected in the donor's blood, HLA antibodies (A2, B57, B58) were detected in the patient's blood. We reported this meaningful case of TRALI that occurred after transfusion of only fresh frozen plasma which did not contain human leukocyte antibody in a patient with HLA antibody.

Complications following an unnecessary peri-operative plasma transfusion and literature review

Plasma is used to correct coagulopathies, but not all coagulation abnormalities are clinically significant enough to require correction before an invasive procedure. We report an 82 year old female who, in response to a mildly prolonged INR of unknown etiology, was unnecessarily transfused with plasma in advance of elective surgery. The patient suffered a moderately severe transfusion reaction, including hives and voice hoarseness, which caused a 4-week delay in her surgery. This delay and adverse reaction could have been avoided had the principles of evidence based plasma therapy, which we herein review, been followed and if the etiology of the mildly elevated INR been investigated before the day of her surgery.

The how's and why's of evidence based plasma therapy

Although traditionally fresh frozen plasma (FFP) has been the product of choice for reversing a significant coagulopathy, the modern blood bank will have several different plasma preparations which should all be equally efficacious in reversing a significant coagulopathy or arresting coagulopathic bleeding. Emerging evidence suggests that for a stable patient, transfusing plasma for an INR< or =1.5 does not confer a hemostatic benefit while unnecessarily exposing the patient to the risks associated with plasma transfusion. This review will discuss the various plasma products that are available and present some of the current literature on the clinical uses of plasma.

Treatment of Trichiasis and Districhiasis with Ellman Dento-Surg 90FFP

PURPOSE: To evaluate the efficacy of the Ellman Dento-Surg 90FFP for the isolated trichiasis or distichiasis. METHODS: 61 eyelashes of 23 patients, who were diagnosed as trichiasis or distichiasis and had less than 5 aberrant cilia that were isolated, were treated with the Ellman Dento-Surg 90FFP. At 1 week, 1 month, 2 month and 6 month postoperatively, we examined the success rate and postoperative complication. RESULTS: Fifteen eyelashes of 9 patients were regrown after mean 1.3month follow-up period (75.4% success rate). Among 10 eyelashes of 6 patients, 2 eyelashes of 2 patients were regrown (80% success rate). Thirteen patients experienced mild burning sensation 1-2 days postoperatively. Eyelid notching was observed in 2 patients. CONCLUSIONS: High frequency radio wave electrosurgery with Ellman Dento-Surg 90FFP is a simple and secure procedure with high success rate and negligible complication, and can be effectively used to treat isolated trichiasis or distichiasis.

Evaluation of the Appropriateness of Red Cells, Platelets and Fresh Frozen Plasma Utilization / 대한진단검사의학회지

BACKGROUND: We reviewed the guidelines for the transfusion of red cells, platelets, and fresh frozen plasma (FFP) of the Korean Society of Blood Transfusion and modified the previous guidelines for transfusions at our hospital. We evaluated the appropriateness of the current hospital transfusions with these algorithms based on these guidelines. METHODS: The medical records of 266 transfusion episodes of patients receiving transfusions of red cells (144), platelets (61), and FFP (61), were reviewed retrospectively at Ewha Womans University Mokdong Hospital during 2002. RESULTS: Inappropriateness rates for transfusion episodes were 2.8% for red cells, 4.9% for platelets, and 44.3% for FFP. 144 red cell transfusions comprised 73 episodes (50.7%) in acute blood loss and 71 (49.3%) in chronic anemia. Among them, 2 episodes in each condition were assessed as inappropriate, respectively. 61 platelet transfusions comprised 32 episodes (52.5%) for a prophylaxis in marrow failure and 13 (21.3%) for active bleeding and 6 (9.8%) for acute disseminated intravascular coagulation (DIC) and 10 (16.4%) for others. Among them, 3 episodes for clinical bleeding were assessed as inappropriate. Out of 61 FFP transfusions, 34 episodes (56%) (16 liver disease with complications, 11 acute DIC, and 7 others) were assessed as appropriate and 27 episodes (44%) (8 liver diseases without complications, 10 surgical procedures and 9 others) were assessed as inappropriate. CONCLUSIONS: We modified our previous guidelines for transfusions according to the transfusion guidelines proposed by the Korean Society of Blood Transfusions. These guidelines could be easily applied to evaluate the appropriateness of transfusions performed at our hospital and to specify the cases of inappropriate transfusions.

A Survey of Blood Component Use in Relation to International Statistical Classification of Diseases (ICD)-10 / 대한임상병리학회지

BACKGROUND: There are few recent studies on transfusion practice and blood use with regard to diagnoses of Korean recipients. We conducted a survey of blood component use in Yonsei University Medical Center in Seoul, Korea. METHODS: A survey was carried out on blood component transfusion from January 2000 to June 2000. Transfused components were listed by broad diagnostic categories formed from the principal diagnoses of the recipients according to the ICD-10. RESULTS: Of all investigated components (67,433 units), 18,623 units of RBCs (27.6%), 10,203 units of FFP (15.1%), 38,547 units of platelets (57.2%), and 60 units of whole blood (0.1%) were transfused. The transfusion rate in relation to sex was 1.7:1 and the majority of all blood units were transfused to patients aged <65 yrs (85.9%). The rate of blood component transfusion was the highest in the department of internal medicine (47,451 units, 70.4%). Of 18,623 RBCs units and 10,203 FFP units, 70.8% and 74.5% were transfused to patients in four diagnostic categories; neoplasms, digestive system diseases, circulatory system diseases, and leukemia or lymphoma. Of 38,547 platelets units, 87.8% were used in patients with neoplasms, leukemia or lymphoma, digestive system diseases and diseases of the blood and blood-forming organs. CONCLUSIONS: This survey provides information on the blood component usage in tertiary-care teaching hospital in Seoul, Korea. It demonstrates the concentration of today's blood utilization among a few diagnostic categories. This information is relevant for quality management of transfusion practice, cost analyses and for planning local and regional blood donation programs.

Investigation of Appropriate Transfusion of Fresh frozen Plasma

BACKGROUND: Recently, clinical use of fresh frozen plasma(FFP) has increased in all blood transfusion activity. But inappropriate uses of FFP may be serious problem due to adverse transfusion reactions, viral transmission, and economic aspects. The aim of this study is to justify clinical indication of FFP by receiving the inappropriate use of them. METHODS: Analyzing hospital records of 115 patients transfused with FFP at Kyung Hee Medical Center from January to April 1998, retrospectively, we investigated the purpose of transfusions, the volume of transfused FFP, and the results of pre- and post-coagulation tests. RESULTS: The most common purpose of transfusions of FFP was plasma volume replacement after surgical operation. Coagulation tests of pre- and post-transfusion were performed 85% and 47%, respectively. Fifty-seven patients(88%) transfused FFP have shown normal results in pre-coagulation tests, and the volume replacement with FFP was done inadequately in 62 cases(54%). CONCLUSION: We conclude that, in order to eliminate side effects due to inappropriate use of FFP, and protect patients, it is necessary to make guidelines of FFP transfusion, educate hospital staffs regularly, and perform pre- and post-coagulation tests routinely for the patients who need FFP transfusion. (Korean J Blood Transfusion 10(1): 5-12, 1999)

Investigation of Appropriate Transfusion of Fresh frozen plasma / 대한수혈학회지

BACKGROUND: Recently, clinical use of fresh frozen plasma (FFP) has increased in all blood transfusion activity. But inappropriate uses of FFP may be serious problem due to adverse transfusion reactions, viral transmission, and economic aspects. The aim of this study is to justify clinical indication of FFP by receiving the inappropriate use of them. METHODS: Analyzing hospital records of 115 patients transfused with FFP at Kyung Hee Medical Center from January to April 1998, retrospectively, we investigated the purpose of transfusions, the volume of transfused FFP, and the results of pre- and post-coagulation tests. RESULTS: The most common purpose of transfusions of FFP was plasma volume replacement after surgical operation. Coagulation tests of pre- and post-transfusion were performed 85% and 47%, respectively. Fifty-seven patients (58%) transfused FFP have shown normal results in pre-coagulation tests, and the volume replacement with FFP was done inadequately in 62 cases (54%). CONCLUSION: We conclude that, in order to eliminate side effects due to inappropriate use of FFP, and protect patients, it is necessary to make guidelines of FFP transfusion, educate hospital staffs regularly, and perform pre- and post-coagulation tests routinely for the patients who need FFP transfusion.