tailieunhanh - Báo cáo y học: "Is fibrinogen the answer to coagulopathy after massive transfusions"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Is fibrinogen the answer to coagulopathy after massive transfusions? | Tisherman Critical Care 2010 14 154 http content 14 3 154 CRITICAL CARE COMMENTARY L__ Is fibrinogen the answer to coagulopathy after massive transfusions Samuel A Tisherman See related research by Grottke etal. http content 14 2 R62 Abstract Coagulopathy is a major cause of morbidity and mortality in patients who have suffered severe hemorrhage and received massive transfusions. Administration of a fibrinogen concentrate along with red blood cells can quickly restore hemostasis in a clinically relevant animal model. Severe traumatic injury is frequently associated with hemorrhagic shock necessitating massive transfusions. Patients frequently become coagulopathic because of the combination of dilution of platelets and clotting factors metabolic acidosis hypothermia and consumption of clotting factors. Although replacement of blood loss with fresh whole blood would be ideal this is not possible in civilian situations under current blood-banking practices. Standard therapy involves the administration of packed red blood cells PRBCs fresh frozen plasma FFP platelets and cryoprecipitate. The last of these is administered primarily to replete fibrinogen which is commonly decreased by dilution as well as consumption. In the previous issue of Critical Care Grottke and colleagues 1 explored the potential use of a fibrinogen concentrate instead. Although these blood products are life-saving they do have risks. In general the more blood products administered particularly PRBCs and FFP the greater the risk for multiple organ system dysfunction and mortality 2-4 . Immunologic responses appear to play a major role. In contrast recent studies have suggested a beneficial effect of cryoprecipitate administration. In a military population of patients receiving massive transfusions the ratio of fibrinogen from all blood products to PRBCs transfused was associated with reduced mortality 5 . Correspondence tishermansa@ Departments of Critical .