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Gong J, Xu L, Li Z, Hu X, Liu J, Teng Y, Jin B, Zhao M, Shi J, Guo T, Shi X, Cheng Y, Liu Y, Qu X. A Clinical Prognostic Score to Predict Survival of Advanced or Metastatic Non-Small Cell Lung Cancer (NSCLC) Patients Receiving First-Line Chemotherapy: A Retrospective Analysis. Med Sci Monit 2018; 24:8264-8271. [PMID: 30446633 PMCID: PMC6252050 DOI: 10.12659/msm.911026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Although several complicated models have been built to evaluate the prognosis of NSCLC patients receiving chemotherapy, simple economic models are still needed to give a preliminary survival assessment of these patients. MATERIAL AND METHODS This study retrospectively assessed the clinical and biological parameters of 223 patients with advanced NSCLC. Univariate and multivariate analyses of overall survival (OS) and progression-free survival (PFS) for the parameters and the prognostic score were assessed. RESULTS Performance status (PS) score=1, smoking history, fibrinogenemia, thrombocytosis, increased lactate dehydrogenase (LDH) level, and anemia were independent predictors of poor prognosis in the univariate analysis of OS and were assessed in multivariate analysis. There was a significant difference in PS=1 (HR=2.134, p<0.0001), increased LDH level (HR=1.508, p=0.014), thrombocytosis (HR=1.547, p=0.012), and smoking history (HR=1.491, p=0.008), based on which the patients were classified into 3 risk groups: low risk (0-1 points), moderate risk (2 points), and high risk (3-5 points). At p values of <0.0001, the median OS was 565, 340, and 273 days and the median progression-free survival was 250, 209, and 135 days, respectively in these 3 risk groups. CONCLUSIONS We established a new prognostic score model using PS, LDH level, PLT count, and smoking history to predict the survival of patients receiving first-line chemotherapy for advanced NSCLC, which might be useful in clinical practice.
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Affiliation(s)
- Jing Gong
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Ling Xu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Zhi Li
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Xuejun Hu
- Department of Respiratory and Infectious Disease of Geriatrics, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Jing Liu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Yuee Teng
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Bo Jin
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Mingfang Zhao
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Jing Shi
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Tianshu Guo
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Xiaonan Shi
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Yu Cheng
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Yunpeng Liu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Xiujuan Qu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
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Gao L, Zhang H, Zhang B, Zhang L, Wang C. Prognostic value of combination of preoperative platelet count and mean platelet volume in patients with resectable non-small cell lung cancer. Oncotarget 2017; 8:15632-15641. [PMID: 28152504 PMCID: PMC5362511 DOI: 10.18632/oncotarget.14921] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/13/2016] [Indexed: 11/25/2022] Open
Abstract
The aim of the present study was to investigate the prognostic value of the combination of preoperative platelet count (PLT) and mean platelet volume (MPV) in patients with primary operable non-small cell lung cancer (NSCLC). We retrospectively analysed data from 546 patients with NSCLC who underwent complete resection at our institution from 2006 to 2010. Patients’ clinical characteristics and laboratory test data at initial diagnosis were collected. Both preoperative PLT and MPV (COP-MPV) were calculated on the basis of the data obtained using the recommended cut-off values of 300 × 109 L−1 and 11.0 fL, respectively. Patients with both an elevated PLT (≥300× 109 L−1) and a decreased MPV (<11.0 fL) were assigned a score of 2, and patients showing one or neither were allocated a score of 1 or 0, respectively. Multivariate analysis of the 9 clinical laboratory variables selected by univariate analysis revealed that preoperative COP-MPV was a significantly independent prognostic factor for overall survival (OS) (hazard ratio, 1.775; 95% confidence interval, 1.500–2.101; P< 0.001) and disease-free survival (DFS) (hazard ratio, 1.719; 95% confidence interval, 1.454–2.033; P< 0.001). In subgroup analyses for tumour pathological stage (I/II/IIIA) patients, we found that the level of COP-MPV was significantly associated with OS and DFS in each subgroup (P< 0.001, P< 0.001, P<0.001 for OS and P<0.001, P< 0.001, P=0.001 for DFS, respectively). In conclusion, the preoperative COP-MPV is a promising predictor of postoperative survival in patients with NSCLC and could classify these patients into three independent groups before surgery.
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Affiliation(s)
- Liuwei Gao
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Lung Cancer Center, Tianjin, China
| | - Hua Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Lung Cancer Center, Tianjin, China
| | - Bin Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Lung Cancer Center, Tianjin, China
| | - Lianmin Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Lung Cancer Center, Tianjin, China
| | - Changli Wang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Lung Cancer Center, Tianjin, China
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Liu YH, Chao CS, Chang YP, Chin HK. Hemostatic resuscitation for massive hemorrhage with warm fresh whole blood in a patient with severe blunt trauma. Asian J Surg 2012; 37:205-7. [PMID: 25300438 DOI: 10.1016/j.asjsur.2012.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 05/11/2012] [Accepted: 06/12/2012] [Indexed: 10/28/2022] Open
Abstract
A 24-year-old male Navy soldier was struck on the left thigh by a ruptured cable and was subsequently thrown into the sea. Initial evaluation showed an Injury Severity Score of 34. Core body temperature was 34.1°C. Laboratory data included a hemoglobin level of 4.5 g/dL and a hematocrit of 13.3%. Prothrombin time was prolonged (>100 seconds), international normalized ratio was elevated (9.99), and partial thromboplastin time was elevated (>180 seconds). The patient was treated for hypothermia, coagulopathy, and metabolic acidosis during resuscitation. The patient was transfused with 16,320 mL of blood during the first 24 hours following the accident, including 4500 mL (18 units) of warm fresh whole blood (WFWB) donated by the patient's military colleagues. The patient was successfully resuscitated, and the injured leg was salvaged. Component therapy can afford replacement of specific deficiencies or requirements, decrease the risk of transfusion-transmitted infectious diseases, and improve resource utilization. However, a protocol of early transfusion with WFWB should be considered during resuscitation following massive hemorrhage in specific conditions such as battle fields or urgent situations.
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Affiliation(s)
- Yuan-Hao Liu
- Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, ROC
| | - Chia-Sheng Chao
- Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, ROC.
| | - Yee-Phoung Chang
- Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, ROC
| | - Hsien-Kuo Chin
- Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, ROC
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Dineen SP, Roland CL, Toombs JE, Kelher M, Silliman CC, Brekken RA, Barnett CC. The acellular fraction of stored platelets promotes tumor cell invasion. J Surg Res 2008; 153:132-7. [PMID: 18541268 DOI: 10.1016/j.jss.2008.04.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 03/27/2008] [Accepted: 04/07/2008] [Indexed: 12/17/2022]
Abstract
BACKGROUND Transfusion of blood products is a potentially life-saving treatment to correct deficits of volume status or oxygen delivery. Increasingly it has been recognized that transfusions also transmit immunosuppressive factors including cytokines and lipid mediators. Platelets are ubiquitously present in blood transfusions and contain numerous growth factors that may contribute to tumor growth. We hypothesized that such growth factors released during routine platelet storage promote cancer invasion. MATERIALS AND METHODS Modified Boyden chamber transwell invasion assays were performed to determine if factors released into the plasma portion of stored platelets could induce tumor cell invasion. RESULTS Soluble mediators from stored platelets induce invasion in two pancreatic cancer cell lines (MIA PaCA-2, Pan02) and one breast cancer cell line (MDA-MB-231). Additionally, we show that vascular endothelial growth factor is present in the acellular fraction of stored platelets and that inhibition of vascular endothelial growth factor with bevacizumab reduces tumor cell invasion in vitro. Finally, we found that in vivo administration of this acellular fraction increases tumor angiogenesis. CONCLUSIONS Components in stored platelets can promote the invasion of multiple cancer cell lines in vitro. These results indicate that factors in platelets may mediate deleterious effects associated with transfusion in cancer patients.
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Affiliation(s)
- Sean P Dineen
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical School, Dallas, Texas 75390, USA
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Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, Sebesta J, Jenkins D, Azarow K, Holcomb JB. Risks associated with fresh whole blood and red blood cell transfusions in a combat support hospital. Crit Care Med 2008; 35:2576-81. [PMID: 17828033 DOI: 10.1097/01.ccm.0000285996.65226.a9] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Fresh whole blood (FWB) and red blood cells (RBCs) are transfused to injured casualties in combat support hospitals. We evaluated the risks of FWB and RBCs transfused to combat-related casualties. DESIGN Retrospective chart review. SETTING Deployed U.S. Army combat support hospitals. SUBJECTS Donors of FWB and recipients of FWB and RBCs. MEASUREMENTS AND RESULTS The storage age of RBCs at transfusion was measured as an indicator of overall risk associated with the storage lesion of RBCs between January 2004 and December 2004 at one combat support hospital. Between April 2004 and December 2004, FWB was prescreened only at one combat support hospital for human immunodeficiency virus, hepatitis C virus, and hepatitis B surface antigen before transfusion. To estimate the general incidence of infectious agent contamination in FWB units, samples collected between May 2003 and February 2006 were tested retrospectively for human immunodeficiency virus, hepatitis B surface antigen, hepatitis C virus, and human lymphotropic virus. Results were compared between FWB samples prescreened and not prescreened for infectious agents before transfusion. At one combat support hospital in 2004, 87 patients were transfused 545 units of FWB and 685 patients were transfused 5,294 units of RBCs with a mean age at transfusion of 33 days (+/- 6 days). Retrospective testing of 2,831 samples from FWB donor units transfused in Iraq and Afghanistan between May 2003 and February 2006 indicated that three of 2,831 (0.11%) were positive for hepatitis C virus recombinant immunoblot assay, two of 2,831 (0.07%) were positive for human lymphotropic virus enzyme immunoassay, and none of 2,831 were positive for both human immunodeficiency virus 1/2 and hepatitis B surface antigen by Western blot and neutralization methods, respectively. The differences in the incidence of hepatitis C virus contamination of FWB donor units between those prescreened for hepatitis C virus (zero of 406; 0%) and not prescreened (three of 2,425; 0.12%) were not significant (p = .48). CONCLUSIONS The risk of infectious disease transmission with FWB transfusion can be minimized by rapid screening tests before transfusion. Because of the potential adverse outcomes of transfusing RBCs of increased storage age to combat-related trauma patients, the risks and benefits of FWB transfusions must be balanced with those of transfusing old RBCs in patients with life-threatening traumatic injuries.
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The Effectiveness of a Damage Control Resuscitation Strategy for Vascular Injury in a Combat Support Hospital: Results of a Case Control Study. ACTA ACUST UNITED AC 2008; 64:S99-106; discussion S106-7. [DOI: 10.1097/ta.0b013e3181608c4a] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hemostasis in Operation Iraqi Freedom III. Surgery 2007; 142:S61-6. [DOI: 10.1016/j.surg.2007.06.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 06/15/2007] [Accepted: 06/15/2007] [Indexed: 11/21/2022]
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Tieu BH, Holcomb JB, Schreiber MA. Coagulopathy: its pathophysiology and treatment in the injured patient. World J Surg 2007; 31:1055-64. [PMID: 17426904 DOI: 10.1007/s00268-006-0653-9] [Citation(s) in RCA: 201] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Hemorrhage continues to be one of the leading causes of death following trauma. Trauma patients are susceptible to the early development of coagulopathy and the most severely injured patients are coagulopathic on hospital admission. Hypothermia, acidosis, and dilution from standard resuscitation can worsen the presenting coagulopathy and perpetuate bleeding. Early identification of coagulopathy is dependent on clinical awareness and point of care laboratory values. Routinely used laboratory coagulation parameters fail to adequately describe this state. Thrombelastography is a test that can be done at the bedside and uses whole blood to provide a functional evaluation of coagulation. Rapid diagnosis of coagulopathy, followed by prevention or correction of hypothermia and acidosis should be a priority during the initial evaluation and resuscitation. Judicious use of resuscitation fluids and early replacement of coagulation factors will help prevent iatrogenic hemodilution. This review covers the pathophysiology as well as the clinical and laboratory diagnosis of coagulopathy. Prevention and treatment strategies are discussed, including early transfusion of coagulation factors during massive transfusion and the use of recombinant factor VIIa. Damage control resuscitation is briefly discussed, and it involves the combination of hypotensive resuscitation and hemostatic resuscitation. Finally, a description of the use of fresh whole blood in the military setting is included. Its use has been proven to be safe and beneficial in this setting and warrants further investigation as an adjunct to the management of civilian trauma patients.
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Affiliation(s)
- Brandon H Tieu
- Department of Surgery, Division of Trauma and Critical Care, Oregon Health & Science University, Portland, Oregon 97239, USA
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Affiliation(s)
- John B Holcomb
- Department of Surgery, The University of Texas Health Science Center at San Antonio, TX, USA.
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Holcomb JB, Jenkins D, Rhee P, Johannigman J, Mahoney P, Mehta S, Cox ED, Gehrke MJ, Beilman GJ, Schreiber M, Flaherty SF, Grathwohl KW, Spinella PC, Perkins JG, Beekley AC, McMullin NR, Park MS, Gonzalez EA, Wade CE, Dubick MA, Schwab CW, Moore FA, Champion HR, Hoyt DB, Hess JR. Damage control resuscitation: directly addressing the early coagulopathy of trauma. ACTA ACUST UNITED AC 2007; 62:307-10. [PMID: 17297317 DOI: 10.1097/ta.0b013e3180324124] [Citation(s) in RCA: 698] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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van de Watering L, Lorinser J, Versteegh M, Westendord R, Brand A. Effects of storage time of red blood cell transfusions on the prognosis of coronary artery bypass graft patients. Transfusion 2006; 46:1712-8. [PMID: 17002627 DOI: 10.1111/j.1537-2995.2006.00958.x] [Citation(s) in RCA: 173] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In different centers for cardiothoracic surgery throughout the world, different policies are followed concerning the maximum storage time of to-be-transfused red blood cells (RBCs). The aim in this study was to investigate the possible role of the storage time of RBC transfusions on the outcome of coronary artery bypass graft (CABG) surgery patients. STUDY DESIGN AND METHODS In a single-center study, all patients who had undergone CABG surgery in the period 1993 until 1999 were identified. Only those patients who had received standard, allogeneic, buffy coat-depleted, unfiltered RBCs in saline-adenine-glucose-mannitol were entered in the analyses (n = 2732). Endpoints were 30-day survival, hospital stay, and intensive care unit (ICU) stay. Storage time of the perioperative RBC transfusions was analyzed in the following four ways: 1) mean storage time of all perioperative RBC transfusions; 2) storage time of the youngest RBC transfusion; 3) storage time of the oldest RBC transfusion; and 4) comparing outcome in patients receiving only RBCs with a storage time below the median storage of 18 days with patients receiving only RBCs with a storage time above the median. RESULTS The univariate analyses showed a strong correlation between storage time and the endpoints survival and ICU stay, but also a correlation with an established risk factor such as the number of transfusions. The multivariate analyses showed no independent effect of storage time on survival or ICU stay. CONCLUSION In these analyses, pertaining to 2732 CABG patients, no justification could be found for use of a particular maximum storage time for RBC transfusions in patients undergoing CABG surgery.
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Affiliation(s)
- Leo van de Watering
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.
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Casati V, D'Angelo A, Barbato L, Rossi E, Grasso MA, Spagnolo S, Panzeri E. Perioperative Management of a Heterozygous Carrier of Glanzmann’s Thrombasthenia Submitted to Coronary Artery Bypass Grafting With Cardiopulmonary Bypass. Anesth Analg 2006; 103:309-11, table of contents. [PMID: 16861409 DOI: 10.1213/01.ane.0000226087.11062.cd] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Glanzmann's thrombasthenia is a congenital hemorrhagic disorder transmitted as an autosomal recessive trait and characterized by altered production and/or assembly of the platelet membrane glycoprotein IIb/IIIa receptor. We describe the perioperative management of a heterozygous carrier of Glanzmann's thrombasthenia submitted to cardiac surgery with cardiopulmonary bypass and the case was complicated by early excessive postoperative bleeding.
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Affiliation(s)
- Valter Casati
- Division of Cardiovascular Anesthesia and Intensive Care, Policlinico di Monza, via Amati 111, Monza (20052), Italy.
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Abrams-Ogg AC. Triggers for prophylactic use of platelet transfusions and optimal platelet dosing in thrombocytopenic dogs and cats. Vet Clin North Am Small Anim Pract 2004; 33:1401-18. [PMID: 14664205 DOI: 10.1016/s0195-5616(03)00095-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Prophylactic platelet transfusions are frequently given to human patients with hypoproliferative thrombocytopenia. For several decades, the most common transfusion trigger was 20,000/microL, but the trend is now to use 10,000/microL in the absence of other risk factors for bleeding. This trigger seems to reduce the number of transfusions without increasing the risk of severe bleeding. Most studies involved in establishing platelet transfusion policies have involved patients with acute leukemia, with fewer studies involving patients undergoing hematopoietic stem cell transplantation or aggressive chemotherapy for other cancers and patients with aplastic anemia. In the presence of other risk factors for spontaneous bleeding, 20,000/microL is still considered an appropriate trigger. The trigger for prophylactic transfusion before surgery has not undergone the same recent scrutiny as has the trigger for spontaneous bleeding. The recommendation remains to raise the platelet count to 50,000 to 100,000/microL if possible, although it is recognized that surgery and other invasive procedures have been performed at lower platelet counts without major bleeding. Prophylactic transfusion is not used in disorders of platelet consumption and destruction to prevent spontaneous bleeding but is used before surgery. Because of the comparative lack of experience with platelet transfusion in veterinary medicine, it is difficult to make generalizations for dogs and cats. Using the guidelines established for therapeutic and prophylactic transfusion of human patients is a reasonable starting point, however. A therapeutic transfusion policy is suggested in the veterinary setting provided that the patient can be closely observed for critical bleeding and a prompt transfusion can be given. This policy should ultimately reduce the overall number of platelet transfusions given to hospital patients. If an animal cannot be closely observed or the ability to transfuse on demand is limited, prophylactic transfusion is recommended. The triggers for initiating a platelet transfusion in dogs are extrapolated from human data; these values are lower by 50% for cats. Because of the imprecision of platelet counting at low values, platelet counts must always be interpreted in conjunction with clinical signs of hemorrhage. If platelet-rich plasma or platelet concentrate is available, a dose of 1 platelet unit per 10 kg is recommended, although resources may dictate a smaller dose. This will raise the recipient platelet count by a maximum of about 40,000/microL. Assuming a trigger of 10,000/microL, a transfusion will probably be required approximately every 3 days. It must be remembered that the frequency of platelet transfusions may be greater in the presence of factors accelerating platelet loss or destruction. If fresh whole blood is used, a rule of thumb is to transfuse 10 mL/kg, which will raise the recipient platelet count by a maximum of approximately 10,000/microL. Daily transfusions or transfusions every other day will probably be required.
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Affiliation(s)
- Anthony C Abrams-Ogg
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
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Ramnath AN, Naber HR, de Boer A, Leusink JA. No benefit of intraoperative whole blood sequestration and autotransfusion during coronary artery bypass grafting: results of a randomized clinical trial. J Thorac Cardiovasc Surg 2003; 125:1432-7. [PMID: 12830065 DOI: 10.1016/s0022-5223(03)00105-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES In a randomized clinical trial of patients undergoing elective coronary artery bypass grafting, we evaluated the effect of intraoperative whole blood sequestration and autotransfusion on postoperative blood loss and the use of allogeneic blood products. METHODS Male patients were included if it was possible to obtain at least 500 mL of autologous blood. For patients in group H (heparin autotransfusion, 50 patients; mean age 59 +/- 8 years), an average of 670 +/- 160 mL heparinized blood was drawn before bypass and reinfused after the period of the extracorporeal circulation. For patients in group C (citrate autotransfusion, 48 patients; mean age 60 +/- 10 years), 450 +/- 109 mL of citrate blood, drawn before administration of heparin, was used. Controls (N-group) consisted of 46 patients aged 62 +/- 8 years. Strict transfusion criteria were used, and blood loss and use of allogeneic blood products during the hospital stays of all patients were recorded. Mean differences with their 95% confidence intervals adjusted for potential confounders were obtained by multiple linear regression. RESULTS The mean difference (95% confidence interval) of blood loss of group H minus N was -93 mL (-307 to 139) and for C minus N was -66 mL (-186 to 179). The mean number of allogeneic blood transfusions for group H was 0.85 +/- 1.74. Group C and group N used 0.94 +/- 1.56 and 0.84 +/- 1.24. CONCLUSION In coronary artery bypass grafting there is no effect of heparin or citrate intraoperative whole blood sequestration with regard to blood loss or use of allogeneic blood.
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Affiliation(s)
- A N Ramnath
- Department of Anesthesiology and Intensive Care, St Antonius Hospital, Nieuwegein, The Netherlands
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Ford SMS, Unsworth-White MJ, Aziz T, Tooze JA, van Besouw JP, Bevan DH, Treasure T. Platelet pheresis is not a useful adjunct to blood-sparing strategies in cardiac surgery. J Cardiothorac Vasc Anesth 2002; 16:321-9. [PMID: 12073204 DOI: 10.1053/jcan.2002.124141] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine whether specific platelet pheresis (minimal plasma harvested) would contribute toward reduced blood loss and allogenic blood requirements after cardiac surgery. DESIGN A prospective randomized trial. SETTING A large cardiothoracic surgical center. PARTICIPANTS Consenting patients undergoing routine coronary artery or valve surgery (n = 54). INTERVENTIONS Patients in the pheresis group underwent platelet pheresis in the anesthetic preparation room before general anesthesia. Pheresed platelets were stored during cardiopulmonary bypass and were returned to the patients after reversal of heparin with protamine toward the end of surgery. Control patients underwent their operations without this intervention. MEASUREMENTS AND MAIN RESULTS Primary endpoints were blood loss and transfusion requirements. There were no differences between the 2 groups (pheresis v control: median loss, 960 mL v 1100 mL, p = 0.15; median blood transfused, 896 mL v 635 mL, p = 0.71). Secondary endpoints included analysis of platelet counts, platelet function, and surface markers. Counts remained the same after retransfusion of platelets up to 2 hours after surgery. Platelet aggregation to ristocetin was well preserved, but adenosine diphosphate caused almost no aggregation of the harvested platelets. Flow cytometry revealed the platelets to have a reduced surface density of the glycoprotein 1b receptor, and 13% of them were irreversibly activated. CONCLUSION Platelet pheresis activates a proportion of the harvested platelets and impairs the function of the remainder; this may explain its failure to reduce postoperative blood loss and transfusion requirements.
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Affiliation(s)
- S M S Ford
- Departments of Cardiothoracic Anaesthesia, Cardiothoracic Surgery, and Haematology, St. George's Hospital, London, United Kingdom
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Abstract
Blood product transfusions can be life saving and must be considered in the supportive care of children of any age with underlying oncological or haematological problems, as well as after major surgery or after serious trauma. Paediatric transfusions are particularly challenging because life-long effects of transfusion complications are more durable and serious in children than in adults, in whom the median age at transfusion is >70 years (Tynell E, Norda R, Shanwell A, Björkman A. Long-term survival in transfusion recipients in Sweden, 1993. Transfusion 2001, 41, 251-255). While the general indications for transfusions in paediatric patients are similar to adults, the threshold, volumes and infusion rates for transfusions vary with age. In this Update, we discuss current blood products, then suggest transfusion "triggers" in major surgery and haematological and oncologic practice. Finally, future developments and new possibilities are considered.
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Affiliation(s)
- B G Solheim
- Institute of Immunology, Rikshospitalet, The National Hospital University of Oslo, NO-0027 Oslo, Norway.
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Martinowitz U, Kenet G, Segal E, Luboshitz J, Lubetsky A, Ingerslev J, Lynn M. Recombinant activated factor VII for adjunctive hemorrhage control in trauma. THE JOURNAL OF TRAUMA 2001; 51:431-8; discussion 438-9. [PMID: 11535886 DOI: 10.1097/00005373-200109000-00002] [Citation(s) in RCA: 199] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recombinant activated factor VII (rFVIIa) was approved for treatment of hemorrhages in patients with hemophilia who develop inhibitors to factors VIII or IX. Conditions with increased thromboembolic risk, including trauma with or without disseminated intravascular coagulation, were considered a contraindication for the drug. The mechanism of action of rFVIIa suggests enhancement of hemostasis limited to the site of injury without systemic activation of the coagulation cascade. Therefore, use of the drug in trauma patients suffering uncontrolled hemorrhage appears to be rational. METHODS Seven massively bleeding, multitransfused (median, 40 units [range, 25-49 units] of packed cells), coagulopathic trauma patients were treated with rFVIIa (median, 120 microg/kg [range, 120-212 microg/kg]) after failure of conventional measures to achieve hemostasis. RESULTS Administration of rFVIIa resulted in cessation of the diffuse bleed, with significant decrease of blood requirements to 2 units (range, 1-2 units) of packed cells (p < 0.05); shortening of prothrombin time and activated partial thromboplastin time from 24 seconds (range, 20-31.8 seconds) to 10.1 seconds (range, 8-12 seconds) (p < 0.005) and 79 seconds (range, 46-110 seconds) to 41 seconds (range, 28-46 seconds) (p < 0.05), respectively; and an increase of FVII level from 0.7 IU/mL (range, 0.7-0.92 IU/mL) to 23.7 IU/mL (range, 18-44 IU/mL) (p < 0.05). Three of the seven patients died of reasons other than bleeding or thromboembolism. CONCLUSION The results of this report suggest that in trauma patients rFVIIa may play a role as an adjunctive hemostatic measure, in addition to surgical hemostatic techniques, and provides the motivation for controlled animal and clinical trials.
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Affiliation(s)
- U Martinowitz
- National Hemophilia Center, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
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Armellin G, Sorbara C, Bonato R, Pittarello D, Dal Cero P, Giron G. Intraoperative plasmapheresis in cardiac surgery. J Cardiothorac Vasc Anesth 1997; 11:13-7. [PMID: 9058213 DOI: 10.1016/s1053-0770(97)90245-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the effects of intraoperative plasmapheresis on total transfusion requirements, mediastinal drainage, and coagulation. DESIGN The trial was prospective, randomized, and controlled. SETTING Inpatient cardiac surgery at a university medical center. PARTICIPANTS Two hundred ninety-three consecutive patients undergoing cardiac surgery requiring cardiopulmonary bypass. INTERVENTIONS Intraoperative plasmapheresis (IP) was performed in 147 patients before heparinization; platelet-rich plasma was reinfused immediately after heparin reversal. MEASUREMENTS AND MAIN RESULTS Mediastinal chest tube drainage during the first 12 postoperative hours was significantly less in the IP group (p = 0.022), but no difference was noted in total postoperative blood loss between the two groups. The amount of packed red cells and fresh frozen plasma transfused to the IP group in the intensive care unit was significantly lower (p = 0.02, p = 0.002, respectively); 51.4% of patients required no transfusion compared with the control group (34.5%) (p = 0.006). No differences were noted for data collected in the intensive care unit in terms of the mean duration of chest tube drainage, ventilator time, or any hematologic variables at baseline or at any subsequent time in the study. CONCLUSIONS After cardiac surgery, intraoperative plasma-pheresis reduces early postoperative bleeding and decreases the need for homologous transfusions.
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Affiliation(s)
- G Armellin
- Department of Anesthesiology and Critical Care, University of Padova, Italy
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Whitten CW, Allison PM. Why is acute preoperative plasmapheresis not uniformly effective at decreasing bleeding following cardiac surgery? J Cardiothorac Vasc Anesth 1993; 7:766. [PMID: 8155141 DOI: 10.1016/1053-0770(93)90083-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Infusion of autologous platelet rich plasma does not reduce blood loss and product use after coronary artery bypass. J Thorac Cardiovasc Surg 1993. [DOI: 10.1016/s0022-5223(19)33772-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mohr R, Sagi B, Lavee J, Goor DA. The hemostatic effect of autologous platelet-rich plasma versus autologous whole blood after cardiac operations: Is platelet separation really necessary? J Thorac Cardiovasc Surg 1993. [DOI: 10.1016/s0022-5223(19)33830-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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