Anticoagulation strategies in venovenous hemodialysis in critically ill patients: a five-year evaluation in a surgical intensive care unit.

Renal failure is a common complication among critically ill patients. Timing, dosage, and mode of renal replacement (RRT) are under debate, but also anticoagulation strategies and vascular access interfere with dialysis success. We present a retrospective, five-year evaluation of patients requiring RRT on a multidisciplinary 50-bed surgical intensive care unit of a university hospital with special regard to anticoagulation strategies and vascular access. Anticoagulation was preferably performed with unfractionated heparin or regional citrate application (RAC). Bleeding and suspected HIT-II were most common causes for RAC. In CVVHD mode filter life span was significantly longer under RAC compared to heparin or other anticoagulation strategies (P=0.001). Femoral vascular access was associated with reduced filter life span (P=0.012), especially under heparin anticoagulation (P=0.015). Patients on RAC had higher rates of metabolic alkalosis (P=0.001), required more transfusions (P=0.045), and showed higher illness severity measured by SOFA scores (P=0.001). RRT with unfractionated heparin represented the most common anticoagulation strategy in this study population. However, patients with bleeding risk and severe organ dysfunction were more likely placed on RAC. Citrate provided longer filter life spans regardless of vascular access site. Attention has to be paid to metabolic disturbances.

How free of residual cells and cell antigens is human blood plasma? A comparison of different production methods of human blood plasma and the risk of the products for patients.

The aim of this investigation was to compare 11 different production procedures for human blood plasma, using preparative apheresis and whole blood. We intended to determine the plasma quality in regard to the number of residual cells or cell fragments. Cells were analysed using the Cell-Dyn 4000 blood cell counter and cell fragments were detected by an immunoassay. Antigenic structure could be detected in clearly different quantities corresponding to the separation technique used. Methods which separated blood components only with centrifugation produced plasma with more detectable cellular material than plasma produced with additional membrane filtration. No remaining antigenic fragments were detected when an additional plasma filter was used.