Therapeutic Effects of Frozen Platelets on the Treatment of Bleeding Caused by Disseminated Intravascular Coagulation
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Objective To evaluate the efficacy of using frozen platelets for treating patients with disseminated intravascular coagulation(DIC). Methods 48 patients with DIC were grouped randomly into two groups. 26 patients received frozen platelets,and 22 patients received fresh platelets. Various parameters,namely the thrombin time (TT),activated partial thromboplasting time (APTT),prothrombin time (PT),fibrinogen (Fbg),and platelet (PLT) were examined at 1 hour before and 2 hours after transfusion. Results With the exception of PLT,significant differences in TT,PT,APTT and Fbg were not observed between the two groups of patients(P0.05). Conclusion Frozen platelets may be used in the patients with DIC.Keywords:
Prothrombin time
Thrombin time
Fresh frozen plasma
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Abstract Background Global hemostatic mechanism(s) in patients with disseminated intravascular coagulation (DIC) are poorly understood. There are few diagnostic criteria of DIC based on overall or global hemostatic mechanisms. Methods We have assessed in detailed the dynamic global hemostatic changes using thrombin and plasmin generation assay (T/P‐GA), clot fibrinolytic waveform analysis (CFWA) and not‐activated rotational thromboelastometry (NATEM), in a young girl with DIC associated with acute myeloid leukemia (AML). The ratios of endogenous thrombin potential (T‐EP) and plasmin lag time (P‐LT) relative to normal plasma was sourced from pooled normal plasma from healthy volunteers on T/P‐GA. Results The inverse P‐LT ratio prior to tranexamic acid (TXA) treatment was greater than the T‐EP ratio (1.1–2.8 and 0.83–1.2, respectively). Significant reduction in inverse P‐LT ratio (0.084–1.3) was observed after TXA treatment. The interval from clotting to the initiation of fibrinolysis (fibrinolysis lag time: FLT) in CFWA was significantly shorter than the control at onset (74.2–91.6 s vs 109 s), indicating enhanced fibrinolysis. Data from an adult with acute promyelocytic leukemia‐associated DIC also supportively showed a high inverse P‐LT ratio (2.1) and shortened FLT (83.7 s). The clotting time in patient whole blood using NATEM‐mode during an episode of severe epistaxis markedly shortened beyond control, but returned to normal after the addition of an anti‐tissue factor (TF) monoclonal antibody. Conclusion The release of intravascular TF contributed to sustained activation of coagulation and subsequent fibrinolytic activity in this patient with AML‐associated DIC, and T/P‐GA could provide better quantitative data than conventional assays in these circumstances.
Thromboelastometry
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The Authors have studied five coagulation parameters (platelets count, prothrombin time, activated partial thromboplastin time, fibrinogen and fibrinogen degradation products) in 60 head traumatized patients. These parameters were alterated in a high percentage of patients. Moreover 5 patients presented laboratory values indicative of disseminated intravascular coagulation (DIC). DIC could be an important factor of mortality in the head traumatized patients. So coagulation system must be carefully evaluated in any patient with head injury.
Prothrombin time
Thromboplastin
Coagulation testing
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Clotting factor
Clotting time
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DISSEMINATED intravascular coagulation (DIC) is a syndrome characterized by hemorrhage, thrombocytopenia, consumption of clotting factors, secondary fibrinolysis with elevated levels of fibrinogen-fibrin degradation products, microangiopathic hemolytic anemia, and fibrin thrombi in blood vessels.1This syndrome occurs in a variety of clinical conditions and is initiated by the liberation of tissue thromboplastin into the circulation, by vascular endothelial damage, by abnormalities of blood flow, or by all three.1Disseminated intravascular coagulation has been recognized as a complication of hypothermia in two series of neonatal infants2,3but has been reported in only one adult patient.4The present report describes a 13-year-old in whom DIC developed during the rewarming phase of accidental hypothermia.
Methods
The prothrombin time was determined using rabbit brain thromboplastin and the activated partial thromboplastin time was performed with a kaolin-activated reagent (Coag-A-Chek). Fibrinogen levels were measured using a standard thrombin reagent (Data-Fi) and fibrinogen determinationCite
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Bleeding time
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Thromboelastometry
Clot retraction
Clotting time
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The influence of hemofiltration on the number of platelets and on coagulation factors was investigated in patients with chronic renal insufficiency. These investigations were done on 12 patients during 22 treatments with hemofiltration. Blood samples were taken before hemofiltration, 10, 30 and 120 minutes after the beginning of the treatment and at the end of hemofiltration. In comparison to the original values we found a loss of platelets, a small decrease in the concentration of fibrinogen and a small increase in the fibrin monomer complex, plasminogen, antithrombin III, alpha1-antitrypsin and in alpha2-macroglobulin. The thrombin time, the partial thromboplastin time and Quick's test showed that the blood of these patients contained sufficient hepatin. Use of fibrin plates (Astrup) showed no signs of fibrinolytic activity. Compared to the results, which were obtained some years ago during hemodialysis, we found a smaller extent of alterations of blood coagulation factors and number of platelets.
Hemofiltration
Thrombin time
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Objective To improve the model of disseminated intravascular coagulation (DIC).Methods DIC was induced by constant iv infusion of thrombin plus PAMBA in rabbits.Platelet count (PLT), PT and fibrinogen (FIB) content plasmaprotamine paracoagulation (3P) test and pathlogical examination of microthrombosis of lungs and kidneys were served as diagnostic indexes of DIC.Results PT in model group was prolonged, PLT and FIB were decreased, 3P test was changed from positive to negative and microthrombosis of lungs and kidneys were formed.Conclusion Iv infusion of thrombin plus PAMBA constant in rabbits can succeed in inducing the DIC.
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Coagulation Disorder
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