Hyperfibrinolysis in Liver Cirrhosis
Pia Glas-Greenwalt in 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.
Primary Hyperfibrino(Geno)Lytic Syndromes
Genesio Murano, Rodger L. Bick in Basic Concepts of Hemostasis and Thrombosis, 2019
One must no longer attribute hemorrhage in the patient with chronic liver disease only to a decrease in the synthesis of Factors II, VII, IX, and X. Numerous defects may occur and when significant or life-threatening hemorrhage develops, this may be due to any one or a combination of the defects that have been defined in the preceeding sections. When approaching the patient with hemorrhage in chronic liver disease, it is a major clinical and clinical laboratory challenge to precisely define those defects that are most likely at fault and to then deliver specific and efficacious therapy. If primary hyperfibrino(geno)lysis is the major contributor to hemorrhage, as it often is, the appropriate therapy would be antifibrinolytic (aminocaproic acid). Fresh frozen plasma will usually correct bleeding associated with decreased and/or defective synthesis of Factors II, VII, IX, and X. If significant thrombocytopenia or platelet dysfunction is present, infusions of platelet concentrates are indicated. When the patient fails to respond to specific therapy directed at clearly defined defects, the use of prothrombin complex concentrates in combination with other components may have to be resorted to. However, this remains investigational and those choosing to use this therapeutic modality should be aware of the potential for disseminated thromboses as well as hepatitis.
The Epidemiology Of Germinal Matrix/ Intraventricular Hemorrhage *
Michele Kiely in Reproductive and Perinatal Epidemiology, 2019
Fresh frozen plasma, rich in clotting factors, has been used for a variety of purposes in newborn care, including treatment of hemorrhagic disease of the newborn. In a controlled trial, Beverley et al. found that its administration in the first hours of life reduced the risk of GM/IVH, but without altering clotting factors in the treated infants.143 The authors speculated that perhaps it was stabilization of blood pressure in the treated group that accounted for the result, inasmuch as no factor-free placebo was used to control for the effect of the plasma infusion itself.
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.
Efficacy and safety of plasmapheresis without plasma transfusion tandem with chemotherapy to treat multiple myeloma
Published in Hematology, 2022
Yigang Guo, Lulu Zhang, Rongyao Zhang, Meiling Zhou, Xu Chen, Chucheng Wan, Ping Hu, Yuanyuan He, Hua Jiang, Wei Geng, Weixing Zhang, Fariha Kanwal, Muhammad Fayyaz ur Rehman, Zhangzhi Li
Multiple myeloma (MM) [1,2] is the second-largest malignant tumor in the hematological system. Damage of an organ or a tissue due to excessive proliferation of plasma cells coupled with abnormal secretions of monoclonal immunoglobulin (M-Ig) or its para protein fragment (M protein/M spike) is the major cause of its pathogenesis. The majority of MM patients were diagnosed with varying degrees of renal impairment, whereas conditions like hyperviscosity, hyperuricemia, and hypercalcemia tend to aggravate renal injury in some MM patients that were further maintained by hemodialysis. Abnormal components of protein and inflammatory factors can be removed rapidly through plasma exchange that enhances the viscosity of blood and helps reduce organ damage caused by the presence of abnormal protein components and inflammatory factors. Traditional plasmapheresis [3–5] requires a large quantity of fresh frozen plasma. The incidence of an anaphylactic reaction that can be significantly enhanced when a large amount of plasma is utilized substantially limits the application of plasmapheresis in multiple myeloma (MM). Therefore, according to the plasma exchange principle, we pursued a clinical study of sequential chemotherapy [6,7] without plasma exchange to treat patients with newly diagnosed multiple myeloma and achieved good results.
Long-term follow-up of children with acute promyelocytic leukemia treated with Beijing Children’s Hospital APL 2005 protocol (BCH-APL 2005)
Published in Pediatric Hematology and Oncology, 2019
Yuanyuan Zhang, Linya Wang, Ruidong Zhang, Peijing Qi, Jing Xie, Huiwen Shi, Wei Lin, Ying Wu, Jiaole Yu, Jia Fan, Guoshuang Feng, Huyong Zheng, Minyuan Wu
Treatment of coagulopathy during the induction phase was based on platelet support to maintain the platelet count at a level greater than 30 × 109/L until the disappearance of coagulopathy. The use of fresh frozen plasma, clotting factors concentrate (prothrombin complex concentrate and fibrinogen concentrate), and platelet transfusions was optional, according to each patient. Prophylaxis and treatment of differentiation syndrome was performed by prednisone (1 mg/kg/d orally) or dexamethasone (10 mg/m2/d intravenously) for at least 3 days if the WBC was >10 × 109/L (before or during treatment with ATRA), or at the earliest sign of ATRA syndrome (dyspnea, lung infiltrates, pleural effusion, unexplained renal failure). In the absence of rapid (<24 hours) improvement of symptoms, ATRA was transiently stopped until clinical control was obtained.
Related Knowledge Centers
- Coagulation
- Volume Expander
- Plasmapheresis
- Allergy
- Thrombus
- Blood Product
- Whole Blood
- Blood Protein
- Blood Type
- Intravenous Therapy