Treatment with combined transfusion of frozen platelets and freshly frozen plasma in acute massive hemorrhage
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Fresh frozen plasma
Platelet Transfusion
Blood preservation
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The data by Ponschab et al. 1 show that reconstituted whole blood using equal numbers of units of packed red blood cells, fresh frozen plasma (FFP) and platelets contains borderline concentrations of fibrinogen. Nonetheless, in severe and continuous haemorrhage, this 1:1:1 mixture currently represents the least unbalanced solution for sustained resuscitation, both from the volume and contents perspectives. An impetus behind Ponschab et al.'s study is the ongoing controversy on how best to give plasma and platelets in trauma resuscitation requiring massive transfusion 2. On one side are clinicians who, backed up by an abundance of non-experimental studies, believe that preventing exsanguination from trauma requires the use of equivalent units of the three main blood components from the start. To achieve this, pre-thawed group-AB plasma must be constantly available such that it can be started as soon as, or almost as soon as, the first unit of universal donor packed red blood cells. This continues until the patient is stabilised, based on clinical signs and blood tests. Many civilian and military trauma centres have adopted this approach. On the other side of the controversy are authors who resist this move, and continue to advocate the traditional approach of ordering FFP and platelets only when one blood volume has been lost acutely, abnormal laboratory results are reported, or microvascular bleeding is obvious. In this latter camp, one important reason for not adopting the 1:1:1 approach is that it has never been validated through randomised controlled studies. This ignores the fact that neither approach has been so validated 3. Unfortunately, there are no randomised controlled trials comparing the two approaches. The data by Ponschab et al. 1 suggest that until we know for sure, frontline clinicians should take the commonsense approach that, in uncontrolled and profuse haemorrhage, one must replace what is lost, and what is lost is whole blood. Given what we know about the state of plasma fibrinogen and its importance in haemostasis and survival, perhaps the best resuscitating mixture in massive haemorrhage should be 1:1:1:1, with cryoprecipitate or the equivalent amount of fibrinogen added.
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Cryoprecipitate
Fresh frozen plasma
Platelet concentrate
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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.
Prothrombin time
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Platelet Transfusion
Bleeding time
Blood product
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The patients of liver resection and postoperative hepatic failure were transfused cryoprecipitate-removed plasma (CRP) and were studied in comparison with the patients transfused fresh-frozen plasma (FFP). CRP was transfused daily to 8 patients (CRP group) from the first postoperative day, FFP to 10 patients (FFP group). Each of 3 patients of postoperative hepatic failure underwent plasma exchanges using CRP and FFP alternately as replacement fluid. Coagulation studies were carried out preoperative day and 1st, 3rd, 5th and 7th postoperative days in the patients of liver resection, and before and after plasma exchange in those of hepatic failure. Compared with FFP, CRP contains 65% of fibrinogen (Fbg) level, 25% of factor VIII clotting activity, 45% of von Willebrand factor antigen (vVF: Ag) level and 50% of fibronectin (FN) level, but other factors, including various proteins, lipids, electrolytes, etc., remain at the same levels.In the postoperative patients there were no discrepancies in the levels of Fbg, factor VIII and FN between CRP group and FFP group. And the levels of Fbg, factor VIII and vWF: Ag (examined only in CRP group) increased postoperatively. The levels of factor VIII and vWF: Ag, which are reported to increase in various liver diseases, and the concentration of Fbg decreased immediately after plasma exchange when CRP was used as replacement fluid, but the levels of these factors were also reduced to the same degree as FFP was used. The concentration of FN increased with CRP after plasma exchange, but diminished with FFP. Although further study of the effect of CRP on FN level is needed, it is concluded that CRP can be substituted for FFP in most liver diseases.
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McCall, Brandi; Idowu, Olakunle; Moreno, Raymond; Price, Kristen; Nates, Joseph Author Information
Fresh frozen plasma
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Cryoprecipitate
Fresh frozen plasma
Blood preservation
Platelet concentrate
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