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Postpartum hemorrhage
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Wade D. Schwendemann, William J. Watson
Fibrinogen should be replaced to keep the level above 100 mg/dL (56). Hemostasis can generally be achieved when the activity of coagulation factors is at least 25% of normal, and when the level of fibrinogen is 100 mg/dL. Since the plasma volume in adults is approximately 40 mL/kg, 10–15 mL/kg of fresh frozen plasma may be needed. This dose is approximately three to five units of FFP for adult patients with BMI in the normal range, and may lead to volume overload. Replacement of fibrinogen can be accomplished in two ways. Transfusion of FFP, one unit (200–300 mL), can be expected to increase the fibrinogen level 7 to 10 mg//dL. FFP also has the advantage of containing virtually all clotting factors, making its administration ideal in the treatment of disseminated intravascular coagulation. Cryoprecipitate contains fibrinogen as well as factors V, VIII, XIII, and vWF. One bag of cryoprecipitate will raise the fibrinogen of the patient by 7 mg/dL. The advantage of cryoprecipitate is the smaller volume that must be infused. This presents an advantage in patients where fluid overload is a concern, such as those with severe pre-eclampsia/HELLP syndrome.
Pregnancy
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Michael E. Newmark, Stephanie Dubinsky
Neonatal hemorrhage can be prevented by the prophylactic administration of oral vitamin K,, 20 mg per day, given to the mother during the last 2 weeks of pregnancy. Aspirin, thiazides, promethazine, and indomethacin are best avoided during the last trimester. Required evaluation of the fetus during labor can be performed by the fetal scalp stimulation test rather than by fetal scalp sampling (68). At birth, the infant should be given the usual prophylaxis of vitamin K,, 1 mg i.m., and closely observed for signs of bleeding. Cord blood of infants exposed to barbiturates and PHT may be tested for prothrombin time, partial thromboplastin time, and, if available, specific factor assays. If bleeding occurs, 10 ml/kg of fresh frozen plasma can be given.
Hyperfibrinolysis in Liver Cirrhosis
Published in Pia Glas-Greenwalt, Fibrinolysis in Disease Molecular and Hemovascular Aspects of Fibrinolysis, 2019
The enhancement of fibrinolysis in patients with liver cirrhosis cannot be regarded separately from the other changes of the hemostatic mechanism. Because a reduction in the vitamin K-dependent coagulation factors is common in both acute and chronic liver disease and vitamin K absorption may be decreased in liver disease, vitamin K should be administered to all these patients prior to surgery or biopsy or if they have features of vitamin K deficiency.2 In patients who bleed extensively, replacement therapy with fresh frozen plasma or concentrates is indicated. A major problem is the volume of fluid and the quantity of the proteins that has to be administered. Prothrombin complex, however, carries the risk of triggering DIC by the presence of activated coagulation factors in the concentrate.122 Cryoprecipitate, containing factor VIII and fibrinogen, can also be given to correct coagulation factor deficiencies. If a decrease of platelets is of major concern, depending on platelet count and bleeding time, platelets concentrates can be administered.
SARS-CoV-2 infection: molecular mechanisms of severe outcomes to suggest therapeutics
Published in Expert Review of Proteomics, 2021
Nicholas Hartog, William Faber, Austin Frisch, Jacob Bauss, Caleb P Bupp, Surender Rajasekaran, Jeremy W Prokop
While small retrospective cohorts have shown potential benefit to convalescent plasma administration in other viral illnesses, prospective studies have failed to demonstrate this same benefit in COVID-19 [184]. Early reports were underpowered, but showed improvement in clinical status in five critically ill patients who received therapeutic convalescent plasma [185]. These early results led to the US food and drug administration (FDA) emergency use authorization (EUA) for hospitalized patients. Initial findings reported that in the first 5,000 patients infused, no increased adverse events were detected as compared to what would be expected from fresh frozen plasma [186]. However, this was a retrospective cohort, with no randomized control group, no central studying monitoring or systematic reporting of side effects, making it unclear how one can interpret these results. The theoretical risk exists of transfusing blood products to critically ill patients remain [187] with no prospective randomized controlled trials and a recent meta-analysis that have shown mortality benefit to administration of convalescent plasma [188–191]. In addition to a lack of proven benefit in hospitalized patients, the NIH has recently halted a trial of convalescent plasma therapy in emergency room patients with mild symptoms after an interim analysis showed no benefit.
Perioperative management of anticoagulation
Published in Hospital Practice, 2020
Goutham Talari, Zachary D. Demertzis, Robert D. Summey, Baljinder Gill, Scott Kaatz
FFP is the serum portion of a unit of whole blood that is frozen in a designated time frame, usually within 8 h, and contains all coagulation factors except platelets. Fresh-frozen plasma corrects coagulopathy by replacing or supplying plasma proteins in patients who are deficient in or have defective plasma proteins. A standard dose of 10–20 mL/kg (4–6 units in adults) will raise factor levels by approximately 20%. An increase of approximately 10% of several factors is enough to effect hemostasis. In addition, FFP provides some volume resuscitation as each unit contains approximately 250 mL. It is stored at −30°C and once thawed, the activity of clotting factors, particularly factor V and factor VIII, decline. After initial dosage, re-administration may be needed every 6–8 h if there is continued bleeding due to the short (2–6 h) half-life of factor VII [46].
Hyperthermic intraperitoneal chemotherapy enhances blood coagulation perioperatively evaluated by thromboelastography: a pilot study
Published in International Journal of Hyperthermia, 2020
Mari Tuovila, Tiina Erkinaro, Heikki Takala, Eeva-Riitta Savolainen, Päivi Laurila, Pasi Ohtonen, Tero Ala-Kokko
Perioperative hemorrhage varied from 100 to 1900 mL and was associated with the stage of peritoneal carcinomatosis and organ manifestations (spleen, liver). On the day before surgery, the mean hemoglobin concentration was 131 g/l (SD 20.4). During the operation the mean hemoglobin concentration was 109 g/l (SD 18.7) at T2, 101 g/l (SD 16.0) at T3, 100 g/l (SD 13.5) at T4 and 105 g/l (SD 15.8) at T5. Five patients required RBC transfusion based on our transfusion limit of 80 g/l. None required platelets. Fresh frozen plasma was given to two patients. All blood products were given before the HIPEC phase, during CRS. Albumin (4%) was used to maintain normovolemia in 12 patients during CRS phase. None of the patients received either blood products or albumin during the HIPEC phase.