RESUMO
The purpose of this retrospective study is to compare the efficacy and safety of the centrifugal separation therapeutic plasma exchange (TPE) using citrate anticoagulant (cTPEc) with membrane separation TPE using heparin anticoagulant (mTPEh) in liver failure patients. The patients treated by cTPEc were defined as cTPEc group and those treated by mTPEh were defined as mTPEh group, respectively. Clinical characteristics were compared between the two groups. Survival analyses of two groups and subgroups classified by the model for end-stage liver disease (MELD) score were performed by Kaplan-Meier method and were compared by the log-rank test. In this study, there were 51 patients in cTPEc group and 18 patients in mTPEh group, respectively. The overall 28-day survival rate was 76% (39/51) in cTPEc group and 61% (11/18) in mTPEh group (P > .05). The 90-day survival rate was 69% (35/51) in cTPEc group and 50% (9/18) in mTPEh group (P > .05). MELD score = 30 was the best cut-off value to predict the prognosis of patients with liver failure treated with TPE, in mTPEh group as well as cTPEc group. The median of total calcium/ionized calcium ratio (2.84, range from 2.20 to 3.71) after cTPEc was significantly higher than the ratio (1.97, range from 1.73 to 3.19) before cTPEc (P < .001). However, there was no significant difference between the mean concentrations of total calcium before cTPEc and at 48 h after cTPEc. Our study concludes that there was no statistically significant difference in survival rate and complications between cTPEc and mTPEh groups. The liver failure patients tolerated cTPEc treatment via peripheral vascular access with the prognosis similar to mTPEh. The prognosis in patients with MELD score < 30 was better than in patients with MELD score ≥ 30 in both groups. In this study, the patients with acute liver failure (ALF) and acute on chronic liver failure (ACLF) treated with cTPEc tolerated the TPE frequency of every other day without significant clinical adverse event of hypocalcemia with similar outcomes to the mTPEh treatment. For liver failure patients treated with cTPEc, close clinical observation and monitoring ionized calcium are necessary to ensure the patients' safety.
Assuntos
Insuficiência Hepática Crônica Agudizada , Doença Hepática Terminal , Humanos , Insuficiência Hepática Crônica Agudizada/terapia , Troca Plasmática/métodos , Estudos Retrospectivos , Heparina/uso terapêutico , Cálcio , Doença Hepática Terminal/terapia , Índice de Gravidade de Doença , Anticoagulantes/uso terapêuticoRESUMO
OBJECTIVE: Through researching preoperative coagulation function in the case of ABO-identical blood insufficient for emergency rescue transfusion according to recommended programs of special emergency rescue transfusion was carried out, the relationship between volume of blood products and coagulation function was analyzed. METHODS: The surgical cases of blood transfusion more than 1 600 ml during operation were collected in our hospitals from Aug 2015 to Dec 2016ï¼n=218ï¼, these cases were divided into the normal coagulation groupï¼Group Aï¼ and abnormal coagulation groupï¼Group Bï¼, and the patients of emergency rescue transfusion O type blood groupï¼Group Cï¼. The basic information of cases, the infused volume of red blood cellï¼RBCï¼, virus-inactivated frozen plasmaï¼VIFPï¼, fresh frozen plasmaï¼FFPï¼, cryoprecipitateï¼Cï¼and plateletsï¼Pï¼, prothrombin timeï¼PTï¼, activated partial thromboplastin timeï¼APTTï¼, fibrinogenï¼FIBï¼and international normalized ratioï¼INRï¼were analyzed, the relationship between volume of blood transfusion and coagulation function were also analysed. At the same time, the efficiency and safety index were compared before and after transfusion. These indexes, such as hemoglobinï¼Hbï¼, indirect bilirubinï¼IBiLï¼, direct antiglobulin testï¼DATï¼and irregular antibody were determined at the time-paints of 24 h, 3 d and 7 d after blood transfusion. RESULTS: The differences of age and blood type between group A and B was not statistically significantï¼P>0.05ï¼. Proportion of A and AB typeï¼transfusion volume of RBC, FFP, C and Plt all were significantly higher in group C ï¼P<0.05ï¼. PT, APTT, FIB and INR in group B and C were significantly differentï¼P<0.05ï¼, which related with the transfusion volume of RBC, FFP and Cï¼P<0.05ï¼. DAT and irregular antibody in every group was all negative before transfusion, No any new irregular antibodies had been detected after transfusion. Hb after blood transfusion was not statistically different before and after transfusion in group C, the IBiL level also was not significantly increased after blood transfusionï¼P > 0.05ï¼. All those showed that emergency rescue transfusion was safe and effective. CONCLUSION: Preoperative coagulation function is one of factors inflnencing blood products transfusion volume during operation, which also is the basis for evaluating bleeding and blood transfusion. Emergency O type blood and ABO-matched blood transfusions show the same efficiency and safety.
Assuntos
Coagulação Sanguínea , Testes de Coagulação Sanguínea , Transfusão de Sangue , Humanos , Tempo de Tromboplastina Parcial , Tempo de ProtrombinaRESUMO
As allogeneic blood transfusion plays a role in clinical treatment effects, it also produces a number of immune-related side effects, such as the increased rate of postoperative infection, the rising relapse rate of malignant resection and so on. All those factors, such as CD200 surface molecule of allogeneic mononuclear cells, interleukin, sHLA and sFasL which are detached from the leukocyte surface during the period of storage, and serum bioactive molecules related to a certain degree with the occurrence of transfusion-related immunomodulation (TRIM). The clinical controlled trials, laboratory researches and animal models demonstrated that cloning deletion, induction of anergy and immune suppression are the three major mechanisms of TRIM. In this article, the research advances on mechanism of TRIM and the mediators inducing TRIM are reviewed.