ABSTRACT
【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.
ABSTRACT
【Objective】 To explore the value of thrombelastogram(TEG) on monitoring the coagulation function and guiding blood transfusion in admitted patients in early stage of severe trauma. 【Methods】 A total of 96 patients in early stage of severe trauma were selected from Ezhou Central Hospital, and were divided into two groups using a random number table method, with 48 patients in each group. The control group was guided by four routine coagulation tests for blood transfusion, while the observation group was guided by TEG.The detection rate of trauma-induced coagulopathy, detection duration, blood infusion volume within 24 hours of admission, coagulation index levels at different time points after blood transfusion, length of hospital stay, ICU stay, and mortality rate between the two groups were compared. 【Results】 The detection rate of trauma-induced coagulopathy was 72.9% in the control group and 93.8% in the observation group(P<0.05). The transfusion volume of fresh frozen plasma (U) and red blood cell (U) in the observation group within 24 hours of admission were significantly lower than those in the control group, which were (35.13±4.75) vs (45.17±6.54), (5.19±1.41) vs (7.08±1.32) (P<0.05); the tranfusion volume of cryoprecipitate (U) and the rate of platelet transfusion in the observation group were significantly higher than those in the control group, which were (36.78±2.49) vs (24.84±3.92), 79.2% vs 22.9%(P<0.05). The APTT(s), PT(s), TT(s), R(min), and K(min) in the observation group 8 hours after blood transfusion were significantly lower than those in the control group, which were (58.16±10.39) vs (70.83±14.99), (15.44±3.22) vs (17.32±2.89), (21.39±4.51) vs (25.18±4.73), (13.03±3.29) vs (14.95±4.57), and (8.07±3.65) vs (10.54±5.14) (P<0.05), while FIB(g/L), MA(mm), α(°), and Plt (×109/L) were higher than those in the control group, which were (2.02±0.46) vs (1.09±0.27), (35.56±11.88) vs (29.57±9.25), (40.07±13.34) vs (27.23±10.87), and (135.87±59.13) vs (108.17±52.08) (P<0.05). 【Conclusion】 TEG can help monitoring the coagulation function in patients in early stage of severe trauma and guide the blood transfusion.
ABSTRACT
【Objective】 To retrospectively analyze the guiding significance and effect of thromboelogram (TEG) in the clinical use of cryoprecipitation. 【Methods】 A total of 289 patients with fibrinogen reduction, admitted to our hospital between January 2018 and December 2021, were collected. They was divided into control group (using coagulation examination and clinical feature as the transfusion criteria) and observation group (above parameters plus TEG). The TEG index in the observation group before and after transfusion and Fg, APTT, PT, and TT in 2 groups of patients before and after transfusion were monitored. The efficacy and prognosis of different blood products and cryoprecipitate were compared between 2 groups of patients.) 【Results】 The efficacy of choprecipitate transfusion was better in the observation group than the control[Fg index after transfusion (g / L) 1.92±0.92 vs 1.80±1.00, P<0.05]. And less blood products were used in observation group as compared with the control[ RBC(U) 1.93±2.69 vs 2.81±3.25 (P<0.05); FFP(mL) 667±378 vs 879±455(P<0.05)]. No differences were noticed by hospital stay between the two groups, but the prognosis in the observed group was significantly better than that in the control. 【Conclusion】 It’s scientific and reasonable to apply TEG to guide the clinical transfusion of cryoprecipitate, so as to save blood resources and improve the prognosis.
ABSTRACT
【Objective】 To establish a blood transfusion outcome prediction model for comprehensivel evaluation of coagulation function of patients with upper gastrointestinal bleeding by thrombelastogram (TEG) and blood coagulation indicators. 【Methods】 The data of 101 patients with upper gastrointestinal hemorrhage, admitted to the Department of Gastroenterology of Zhejiang Provincial People′s Hospital and its Chun′an Branch from June 2018 to June 2021, were collected through Tongshuo blood transfusion management system and His system. Those patients were divided into blood transfusion group (n=56) and non-transfusion group (n=45), and into cirrhosis group (n=74) and non-cirrhosis group (n=27), and 40 patients, with non-upper gastrointestinal bleeding, were enrolled as the control. The results of TEG indicators (R, K, α, MA), coagulation function (PT, INR, APTT, TT, Fib), blood routine (Hb, Plt, WBC, NEUT%) and biochemical detection(Alb, SCr, ALT, AST, GGT) before transfusion were compared between groups and the correlation between TEG indicators and traditional coagulation parameters was analyzed. Single-factor and multi-factor analysis were used to screen blood transfusion-related factors to establish a predictive model. 【Results】 The comparisons of paremeters between transfusion and non-transfusion group were as follows, K (min), α (°), and MA (mm) was 3.86±3.12 vs 2.50±1.47, 54.00±14.08 vs 61.05±10.88, and 51.12±13.37 vs 58.26±11.08, respectively (P<0.01); PT (s) and Fib (g) was 16.36±7.45 vs 13.44±1.50 and 1.59±0.87 vs 2.35±1.09 (P<0.01); NEUT% and Hb (g/L) was 0.75 ±0.13 vs 0.66±0.15 and 68.04±14.49 vs 100.73±22.92 (P<0.01); Alb (g/L) and SCr (nmol/L) was 29.73±6.08 vs 33.73±7.19 and 99.50±53.55 vs 76.25±19.28 (P<0.01). Correlation analysis showed that APTT was positively correlated with R and K values, and negatively correlated with α and MA. Fib was negatively correlated with K values, and positively correlated with α and MA. Plt was negatively correlated with K values, and positively correlated with α and MA (P<0.01). Eight pre-transfusion indicators as K, MA, PT, Fib, NEUT%, Hb, Alb, and SCr were subjected to Logistic regression to establish a blood transfusion prediction model. The optimal ROC curve of blood transfusion threshold (blood transfusion predictive value of patients), sensitivity, specificity and AUC were 0.448, 92.9%, 88.9%, and 0.969, respectively. 【Conclusion】 The establishment of Logistic regression model by integrating detection indicators of TEG, coagulation function, blood routine and biochemistry in patients with upper gastrointestinal bleeding have showed significant correlation with blood transfusion prediction, and good clinical practicability.