fibrin and Transfusion-Reaction

Topics: Animals; Blood Platelets; Blood Preservation; Blood Transfusion; Cell Aggregation; Disease Models, Animal; Dogs; Fibrin; Humans; Leukocytes; Micropore Filters; Papio; Platelet Aggregation; Postoperative Complications; Pulmonary Embolism; Respiratory Distress Syndrome; Transfusion Reaction

Topics: Adult; Anticoagulants; Blood Coagulation; Blood Coagulation Factors; Blood Group Incompatibility; Blood Platelets; Blood Preservation; Blood Transfusion; Costs and Cost Analysis; Erythrocyte Aging; Erythrocytes; Female; Fibrin; Hemoglobins; Hepatitis B; Humans; Hydrogen-Ion Concentration; In Vitro Techniques; Phosphates; Plasma; Pregnancy; Transfusion Reaction

Blood dilution after transfusion fluids leads to diminished coagulant activity monitored by rotational thromboelastometry, assessing elastic fibrin clot formation, or by thrombin generation testing. We aimed to determine the contributions of blood cells (platelets, red blood cells) and plasma factors (fibrinogen, prothrombin complex concentrate) to fibrin clot formation under conditions of haemodilution in vitro or in vivo.Whole blood or plasma diluted in vitro was supplemented with platelets, red cells, fibrinogen or prothrombin complex concentrate (PCC). Thromboelastometry was measured in whole blood as well as plasma; thrombin generation was determined in parallel. Similar tests were performed with blood from 48 patients, obtained before and after massive fluid infusion during cardiothoracic surgery.Addition of platelets or fibrinogen, in additive and independent ways, reversed the impaired fibrin clot formation (thromboelastometry) in diluted whole blood. In contrast, supplementation of red blood cells or prothrombin complex concentrate was ineffective. Platelets and fibrinogen independently restored clot formation in diluted plasma, resulting in thromboelastometry curves approaching those in whole blood. In whole blood from patients undergoing dilution during surgery, elastic clot formation was determined by both the platelet count and the fibrinogen level. Thrombin generation in diluted (patient) plasma was not changed by fibrinogen, but improved markedly by prothrombin complex concentrate. In conclusion, in dilutional coagulopathy, platelets and fibrinogen, but not red blood cells or vitamin K-dependent coagulation factors, independently determine thromboelastometry parameters measured in whole blood and plasma. Clinical decisions for transfusion based on thromboelastometry should take into account the platelet concentration.

Topics: Aged; Blood Coagulation; Blood Platelets; Cardiopulmonary Bypass; Erythrocytes; Female; Fibrin; Fibrinogen; Hemodilution; Hemorrhage; Humans; Male; Middle Aged; Platelet Count; Prothrombin; Thrombelastography; Thrombin; Transfusion Reaction

Topics: Bacteria; Blood Banks; Cross Infection; Fibrin; Humans; Orthopedics; Risk Assessment; Transfusion Reaction

Fibrin glue (FG), made with highly concentrated human fibrinogen and clotting factors, was used to achieve parenchymal organ hemostasis in patients with disordered coagulation secondary to massive transfusion, chronic disease, and disseminated intravascular coagulation; it was effective in controlling liver hemorrhage in seven patients and in the performance of a splenorrhaphy in one other patient. The coagulation profile was grossly abnormal in all patients, and the mean +/- SD intraoperative blood loss was 5.1 +/- 4.2 L; patients received 14 +/- 10 U of blood perioperatively. The amount of FG required to achieve hemostasis varied directly with the extent of injury and intraoperative blood loss (r = .84), and all patients with a blood loss greater than 4 L required at least 25 mL of FG to stop bleeding. Two patients died postoperatively secondary to cardiac arrest and adult respiratory distress syndrome. Because FG does not depend on adequate platelet or clotting factor levels to be effective, it is especially useful in patients with parenchymal organ hemorrhage and disordered coagulation.

Topics: Adult; Aged; Aprotinin; Blood Coagulation Disorders; Chronic Disease; Disseminated Intravascular Coagulation; Drug Combinations; Factor XIII; Female; Fibrin; Fibrin Tissue Adhesive; Fibrinogen; Hemostasis, Surgical; Humans; Liver; Male; Spleen; Thrombin; Tissue Adhesives; Transfusion Reaction

Systemic hemostatic agents are reviewed. Among the agents discussed are vitamin K preparations (phytonadione, menadione, menadione sodium bisulfite, menadiol sodium diphosphate); and blood products (whole blood, plasma, cryoprecipitate, factor VIII concentrates, factor IX concentrates and fibrinogen concentrates). Normal and abnormal hemostasis and fibrinolysis are discussed, as is the general management of systemic hemostatic defects. Specific disorders covered are clotting factor deficiencies, hemophilia A, factor VIII inhibitors, von Willebrand disease, hemophilia B (Christmas disease), other congenital coagulation disorders, acquired deficiency of factors II, VII, IX and X, and defibrination syndrome.

Topics: Antibodies; Blood Coagulation Disorders; Factor VIII; Fibrin; Fibrinolysis; Hemophilia A; Hemophilia B; Hemostasis; Hemostatics; Humans; Transfusion Reaction; von Willebrand Diseases

Topics: Blood Preservation; Fibrin; Humans; Leukocytes; Micropore Filters; Platelet Aggregation; Respiratory Distress Syndrome; Transfusion Reaction

Sufficient clotting factors to ensure coagulation and replacement of lost volume and oxygen-carrying capacity are necessary to obviate many of the complications that may occur when massive transfusions are used in patients with multiple injuries. A regimen that has been successful includes immediate infusion of plasma protein fraction, packed red cells, fresh-frozen plasma, and nonspecific platelets.

Topics: Blood Coagulation Disorders; Blood Coagulation Factors; Blood Platelets; Blood Proteins; Blood Transfusion; Disseminated Intravascular Coagulation; Fibrin; Humans; Respiratory Insufficiency; Thrombocytopenia; Transfusion Reaction; Wounds and Injuries

Topics: Blood Group Incompatibility; Blood Transfusion; Erythrocytes; Fibrin; Fibrinogen; Humans; Serum Albumin; Transfusion Reaction; Wounds and Injuries

Topics: Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; Blood Platelet Disorders; Blood Platelets; Cell Aggregation; Cell Count; Factor V; Factor VII; Factor X; Fibrin; Fibrinolysin; Humans; Plasminogen; Time Factors; Transfusion Reaction; Wounds and Injuries

Topics: Aged; Anticoagulants; Autopsy; Capillaries; Dextrans; Embolism; Female; Fibrin; Hemorrhage; Humans; Infusions, Parenteral; Kidney Glomerulus; Male; Postoperative Complications; Transfusion Reaction

Topics: Animals; Blood Coagulation Disorders; Blood Coagulation Tests; Blood Group Incompatibility; Dogs; Female; Fibrin; Fibrinogen; Fibrinolysis; Heparin; Immunoelectrophoresis; Male; Rats; Shock; Thrombelastography; Transfusion Reaction

Topics: Blood Coagulation; Blood Transfusion; Fibrin; Surgical Procedures, Operative; Transfusion Reaction

Topics: Blood Transfusion; Fibrin; Humans; Thrombelastography; Transfusion Reaction