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Blood Transfusion Strategies in Trauma Patients
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Transfusion plays a vital role in the management of massively bleeding trauma patients. These patients generally present with bleeding and coagulopathy in the emergency department. Patients presenting with coagulopathy carry a higher risk of mortality. Early initiation of blood component therapy has the potential to improve the clinical outcome and prevent mortality in these patients. Inappropriate blood transfusions can cause haemodilution, which can worsen acidosis, hypothermia and coagulopathy (the lethal triad of massive blood loss) in bleeding patients. Ratio-based balanced blood component therapy as a part of damage control resuscitation is the most accepted strategy for blood transfusion in trauma patients with massive bleeding. Tables 17.1 and 17.2 describe various blood components and products, respectively, and their role in trauma resuscitation.
Amniotic Fluid Embolism
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
There is a biphasic haemodynamic response in AFE, which leads to right and left ventricular failure, profound hypotension and shock. This is followed by a phase of coagulopathy, triggered by the activation of coagulation factors by procoagulant products contained in the amniotic fluid and fetal cells. It is also speculated that coagulopathy may be compounded by massive hyperfibrinolysis because of the increased concentrations of urokinase-like plasminogen activator and plasminogen activator 1 present in the amniotic fluid. Coagulopathy leads to profound bleeding. It is also hypothesised that the entry of amniotic fluid into the maternal circulation increases the plasma concentration of endothelin, which acts as a bronchoconstrictor as well as a pulmonary and coronary vasoconstrictor, and this may contribute to cardiorespiratory arrest.
Vascular anomalies
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Eileen M. Duggan, Steven J. Fishman
In patients with certain anomalies that are more high-risk (e.g. multifocal or extensive VMs, LVMs, CLVMs), we recommend more extensive preoperative hematologic evaluation. These patients are more likely to have chronic consumptive coagulopathies. While the coagulopathy does not normally cause serious problems at baseline, it can worsen with surgical resection or other major procedures and lead to serious systemic bleeding and thrombotic complications. Therefore, preoperative plasma d-dimer, fibrinogen, platelets, PT, and PTT should be drawn. Concerning numbers include a d-dimer more than 20 times the upper limit, fibrinogen levels <100 mg/dL, elevated PT or PTT, and thrombocytopenia. In cases of lab abnormalities, replacement therapy with platelet or cryoprecipitate should be given perioperatively to keep fibrinogen greater than 100 mg/dL and platelet counts over 100 000/μL. The administration of low-molecular weight heparin may bring fibrinogen to normal levels without the need for cryoprecipitate.
Microwave ablation without subsequent lumpectomy versus breast-conserving surgery for early breast cancer: a propensity score matching study
Published in International Journal of Hyperthermia, 2023
Yu-qing Dai, Ping Liang, Jiandong Wang, Yan-chun Luo, Xiao-Ling Yu, Zhi-Yu Han, Fang-yi Liu, Xin Li, Shui-lian Tan, Zhen Wang, Chong Wu, Jian-ming Li, Jie Yu
The inclusion criteria were as follows: (i) female patients; (ii) primary BC without previous treatment; (iii) breast invasive carcinoma diagnosed by histology; (iv) cTNM stage of T0/1/2N0/1M0; (v) lesions detected clearly on the US for patients who chose to perform MWA. The exclusion criteria were as follows: (i) patients reluctant to undergo MWA or BCS; (ii) patients who underwent subsequent mammectomy after MWA or BCS; (iii) >3 multifocal or extensive carcinomas; (iv) diffuse malignant calcification; (v) inflammatory BC, Paget disease or mastitis; (vi) history of other malignancies; (vii) severe coagulopathy; (viii) pregnant or breastfeeding; (ix) loss to follow up. Patients who met all the inclusion criteria and none of the exclusion criteria were enrolled in the study.
Treatment outcomes after radiofrequency ablation in patients with non-B non-C hepatocellular carcinoma within Milan criteria: comparison with HBV-related hepatocellular carcinoma
Published in International Journal of Hyperthermia, 2023
Baoxian Liu, Yang Tan, Hui Shen, Lin Wang, Guangliang Huang, Tongyi Huang, Haiyi Long, Xiaoyan Xie, Xiaohua Xie
The inclusion criteria were as follows:Adults with primary HCC within the Milan criteria.No previous treatment for HCC.Patients tested with a preoperative examination of serological viral markers within 1 week before RFA.Child-Pugh grade of liver function was class A or B.East Coast Oncology Group (ECOG) performance score of 0 or 1.No severe coagulopathy.
Endovascular treatment for cerebral venous sinus thrombosis – a single center study
Published in British Journal of Neurosurgery, 2021
Thomas Hasseriis Andersen, Klaus Hansen, Thomas Truelsen, Mats Cronqvist, Trine Stavngaard, Marie Elisabeth Cortsen, Markus Holtmannspötter, Joan L Sunnleyg Højgaard, Jakob Stensballe, Karen Lise Welling, Henrik Gutte
A total of 28 patients underwent endovascular therapy in the 11-year study period and are described in Tables 1–6. There were 21 females (75%), median age was 37.5 years (range 15–76 years; median age women 31.0 years; median age men 53.0 years). The majority of patients (n = 25; 89%) had 3 or more presenting symptoms with the most common being headache (71%), hemiparesis (39%) and aphasia (18%), Table 1. Fourteen patients (50%) had one or more seizures. Impaired consciousness was present in 18 patients (64%) and 8 patients (29%) were comatose. Median Glasgow Coma scale (GCS) at tertiary care admission was 9.5 (range 4–13). Median time from presenting signs and symptoms to diagnosis was 4 days (range 1–19 days). Eighty-two percent of patients had thrombosis of 2 or more sinuses, Table 2 and 3. Intracranial hemorrhage, all intracerebral, was observed in 18 patients (64%), Table 2. Etiology/risk factors are presented in Table 1. In the female patients, oral contraceptive pill usage or puerperium were present in the majority (n = 16; 76%). In 2 patients no etiology or risk factor was identified. Coagulopathy assessments were available for 21 patients and were abnormal in 8 (29%).