Obstetric Hemorrhages on the Background of Gestosis: a Modern Therapeutic Management (Review of Literature)

Obstetric hemorrhages are a topical problem of modern health care. They are remains one of the principal causes of maternal death. A series of therapeutic measures for stopping obstetric hemorrhage worked for decades. Recently, however, a number of pharmacological and surgical methods that ensure a more effective management of postpartum hemorrhages have been introduced, which in its turn results in preservation of the reproductive function in young women. This article presents the world literature data on the theories of gestosis, its frequencies, pathogenesis and the role of gestosis in the development of obstetric hemorrhage. It is shown that the hyper-coagulable syndrome and hypovolemia, specific to gestosis, are directly related to the decrease of tolerance of the female body during obstetric hemorrhage, as well as they lead to the disruption of compensatory reactions with the development of multiple organ dysfunction syndrome, even at a small loss of blood. The article describes the modern conserving approach for the management of obstetric hemorrhage and the role of integrated infusion- transfusion therapy with early addition of donor fresh frozen plasma in the treatment of bleeding in the early postpartum period to preserve the reproductive function of women.

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A fatal toxic shock-like syndrome post COVID-19 infection in a child

Italian Journal of Pediatrics ◽

10.1186/s13052-021-01070-z ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Houda Ajmi ◽

Wissem Besghaier ◽

Wafa Kallala ◽

Abdelhalim Trabelsi ◽

Saoussan Abroug

Keyword(s):

Ejection Fraction ◽

Pediatric Intensive Care ◽

Fresh Frozen Plasma ◽

Multiple Organ ◽

Clinical Feature ◽

Fresh Frozen ◽

Life Threatening ◽

High Doses ◽

Definition Of ◽

High Level

Abstract Background Children affected by Coronavirus disease 2019 (COVID-19) showed various manifestations. Some of them were severe cases presenting with multi-system inflammatory syndrome (MIS-C) causing multiple organ dysfunction. Case presentation We report the case of a 12-year-old girl with recent COVID-19 infection who presented with persistent fever, abdominal pain and other symptoms that meet the definition of MIS-C. She had lymphopenia and a high level of inflammatory markers. She was admitted to pediatric intensive care unit since she rapidly developed refractory catecholamine-resistant shock with multiple organ failure. Echocardiography showed a small pericardial effusion with a normal ejection fraction (Ejection Fraction = 60%) and no valvular or coronary lesions. The child showed no signs of improvement even after receiving intravenous immunoglobulin, fresh frozen plasma, high doses of Vasopressors and corticosteroid. His outcome was fatal. Conclusion Pediatric patients affected by the new COVID-19 related syndrome may show severe life-threatening conditions similar to Kawasaki disease shock syndrome. Hypotension in these patients results from heart failure and the decreased cardiac output. We report a new severe clinical feature of SARS-CoV-2 infection in children in whom hypotension was the result of refractory vasoplegia.

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The Effect of Adjunctive Fresh Frozen Plasma Administration on Coagulation Parameters and Survival in a Canine Model of Antivenom-treated Brown Snake Envenoming

Anaesthesia and Intensive Care ◽

10.1177/0310057x0503300106 ◽

2005 ◽

Vol 33 (1) ◽

pp. 36-40 ◽

Cited By ~ 23

Author(s):

G. A. Jelinek ◽

A. Smith ◽

D. Lynch ◽

A. Celenza ◽

I. Irving ◽

...

Keyword(s):

Platelet Count ◽

Early Death ◽

Canine Model ◽

Fresh Frozen Plasma ◽

Dose Administration ◽

Fresh Frozen ◽

Venom Dose ◽

Clotting Disorder ◽

Frozen Plasma

This study aimed to assess the effects of dugite envenoming on blood coagulation and platelet count in a canine model, and the efficacy of fresh frozen plasma (FFP) in reversing the clotting disorder after both adequate and inadequate venom neutralization. Following initial dosing and administration studies, an intravenous venom dose of 1μg/kg was administered to eleven dogs. This was followed 30 minutes later by antivenom in either adequate or inadequate doses. A further 30 minutes later, the animals were given either two units of their own FFP or saline. Fibrinogen, aPTT and platelet levels were monitored for eight hours. Of the six study dogs given antivenom plus FFP, two died at around 60 to 90 minutes post envenoming, at the end of the FFP infusions, and all but one of the survivors had persistent afibrinogenaemia. Of the five study dogs given antivenom and no FFP, all but one had return of detectable fibrinogen at eight hours after envenoming. The platelet count fell in all animals with recovery independent of antivenom dose, administration of FFP, or regeneration of fibrinogen. Post mortem examinations of dogs that died during dosage and administration studies showed massive intracardiac clots. We conclude that early death from Brown Snake envenoming may be due to massive intravascular clotting. FFP administration was associated with persistent afibrinogenaemia regardless of antivenom dose. In the absence of any evidence for its efficacy, this study suggests that the role of FFP after Brown Snake envenoming should be reconsidered.

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Perioperative management of coagulation

Hämostaseologie ◽

10.1055/s-0037-1617076 ◽

2006 ◽

Vol 26 (S 02) ◽

pp. S3-S14 ◽

Cited By ~ 2

Author(s):

P. Innerhofer

Keyword(s):

Coagulation Factor ◽

Fresh Frozen Plasma ◽

Laboratory Evaluation ◽

Blood Component ◽

Actual Case ◽

Fresh Frozen ◽

Coagulation Factor Concentrates ◽

Hemostatic Therapy ◽

Frozen Plasma

SummaryGuidelines of official societies for diagnosis and therapy of intraoperatively occurring hypocoagulability rely mainly on data of patients receiving whole blood transfusions. They recommend -provided that laboratory evaluation shows deficiency (values >1.5 fold normal)- administration of fresh frozen plasma, cryoprecipitate and platelet concentrates (platelet count <50 000 or <100 000/μl). This article describes the pathogenesis of coagulopathy in the light of the special intraoperative setting, emphasizes recent changes of blood component preparation, transfusion triggers, effects of volume therapy and challenges standard laboratory assays as reliable guide for intraoperative hemostatic therapy. The role of thrombelastographic monitoring is discussed as well as an alternative strategy to compensate deficiencies by the use of coagulation factor concentrates instead of or in addition to transfusion of FFP, a new concept which is illustrated by the presentation of an actual case report.

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The effect of plasmapheresis on plasma cholinesterase levels in a patient with organophosphate poisoning

Human & Experimental Toxicology ◽

10.1191/0960327104ht462cr ◽

2004 ◽

Vol 23 (7) ◽

pp. 365-368 ◽

Cited By ~ 15

Author(s):

Muhammet Güven ◽

Murat Sungur ◽

Bülent Eser

Keyword(s):

Normal Values ◽

Fresh Frozen Plasma ◽

Plasma Cholinesterase ◽

Organophosphate Poisoning ◽

Fresh Frozen ◽

Medical Intensive Care ◽

High Level ◽

Plasma Measurements ◽

Frozen Plasma

Objective: To describe the role of plasmapheresis in management of organophosphate poisonings. Design: Case report. Setting: A medical intensive care unit of a medical faculty. Patient: A patient with organophosphate poisoning whose cholinesterase levels continuously decline and then increase up to a normal level after plasmapheresis is performed for his sepsis. Interventions: Plasmapheresis with fresh frozen plasma. Measurements and main results: Baseline plasma cholinesterase (ChE) level was 4001 IU/L (normal values: 4000-10000 IU/L). Aspiration pneumonia was developed on day 3, and sepsis occurred on day 5. During this period, ChE levels gradually decreased. On day 5, plasmapheresis was performed for sepsis. Interestingly, plasma ChE levels increased from 2101 IU/L to 6144 IU/L after plasmapheresis. Atropine and pralidoxime were stopped, and a high level of ChE continued during hospitalization. The patient was successfully weaned from mechanical ventilation 3 days after plasmapheresis. Conclusion: Plasma exchange therapy may be considered for patients with organophosphate poisoning unresponsive to atropine and pralidoxime.

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Clinical experience of factor XI deficiency: the role of fresh frozen plasma and factor XI concentrate

Haemophilia ◽

10.1111/j.1365-2516.1995.tb00080.x ◽

1995 ◽

Vol 1 (4) ◽

pp. 227-231 ◽

Cited By ~ 29

Author(s):

P.W. COLLINS ◽

E. GOLDMAN ◽

P. LILLEY ◽

K. J. PASI ◽

C. A. LEE

Keyword(s):

Clinical Experience ◽

Fresh Frozen Plasma ◽

Factor Xi ◽

Factor Xi Deficiency ◽

Fresh Frozen ◽

Frozen Plasma

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Exertional Heat Stroke and Susceptibility to Malignant Hyperthermia in an Athlete: Evidence for a Link?

Journal of Athletic Training ◽

10.4085/1062-6050-50.12.01 ◽

2015 ◽

Vol 50 (11) ◽

pp. 1212-1214 ◽

Cited By ~ 19

Author(s):

Mathias Poussel ◽

Philippe Guerci ◽

Pierre Kaminsky ◽

Marie Heymonet ◽

Nathalie Roux-Buisson ◽

...

Keyword(s):

Malignant Hyperthermia ◽

Oxidative Metabolism ◽

Heat Stroke ◽

Return To Sport ◽

Fresh Frozen Plasma ◽

Multiple Organ ◽

Exertional Heat Stroke ◽

Ryr1 Gene ◽

Missense Variation ◽

Fresh Frozen

Objective To describe the possible association (pathophysiologic and clinical features) between exertional heat stroke (EHS) and malignant hyperthermia (MH). Background Both EHS and MH are acute and life-threatening disorders. It has repeatedly been shown that EHS can occur in well-trained patients with known MH-associated mutation in the RYR1 gene in the absence of any extreme environmental conditions or extreme physical activity, thereby supporting a possible link between EHS and MH. In this case, a highly trained 30-year-old male athlete suddenly collapsed while running. He had initial hyperthermia (40.2°C) and progressive multiple organ failure requiring medical management in an intensive care unit. After he recovered completely, a maximal exercise test was performed and showed an obvious abnormality of oxidative metabolism in muscle; genetic analysis of the RYR1 gene identified a heterozygous missense variation p.K1393R. Consequently, the athlete was given appropriate information and allowed to progressively return to sport competition. Differential Diagnosis Doping, use of drugs and toxic agents, exercise-associated hyponatremia, exertional heat illness. Treatment Initial management started with the basic resuscitative guidelines of airway, breathing, and circulation (intubation). Cooling, administration of fresh frozen plasma, and intensive rehydration resulted in improvement. Uniqueness To our knowledge, ours is the first description of this MH mutation (p.K1393R) in the RYR1 gene that was associated with exertional rhabdomyolysis involving a dramatic impairment of oxidative metabolism in muscle. Conclusions Common features are shared by EHS and MH. Careful attention must therefore be paid to athletes who experience EHS, especially in temperate climates or when there are no other predisposing factors.

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Organizational measures for the prevention of complications of blood transfusion

Kazan medical journal ◽

10.17816/kmj2346 ◽

2012 ◽

Vol 93 (2) ◽

pp. 383-384

Author(s):

N I Stepanova ◽

N A Polyanin

Keyword(s):

Blood Transfusion ◽

Essential Element ◽

Fresh Frozen Plasma ◽

Blood Components ◽

Medical Department ◽

Transfusion Therapy ◽

Surgical Interventions ◽

Fresh Frozen ◽

Passport Data ◽

Instructions For Use

Organization of the blood transfusion therapy in a hospital is an essential element in delivering medical care to the wounded, injured and sick. In each medical department of the hospital a physician responsible for the organization of transfusion therapy is appointed by the order of the chief. The provision of donor blood and its components for the elective surgical interventions is carried out on the basis of preliminary requests of the attending physicians. It is unacceptable to conduct elective surgical interventions without the required number of screened blood components. In order to conduct blood transfusions when providing emergency care there should be a supply of fresh frozen plasma and frozen erythrocytes in the hospital in the amount of a monthly requirement. All blood transfusion must have a clear clinical rationale and should be performed in strict accordance with current instructions for use of blood components. The completed measures for determination of blood component’s compatibility with the blood of the recipient, the name, amount, passport data of each transfusion environment have to be reflected in the blood transfusion protocol.

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Infusion-transfusion therapy in the treatment of patients with acute bleedings from the upper gastrointestinal tract

Kazan medical journal ◽

10.17816/kmj2350 ◽

2012 ◽

Vol 93 (2) ◽

pp. 390-394

Author(s):

G R Khalikova ◽

I S Malkov ◽

V V Fattakhov ◽

M N Nasrullaev

Keyword(s):

Gastrointestinal Tract ◽

Blood Loss ◽

Fresh Frozen Plasma ◽

Endoscopic Hemostasis ◽

Upper Gastrointestinal Tract ◽

Infusion Therapy ◽

Transfusion Therapy ◽

Fresh Frozen ◽

Upper Gastrointestinal ◽

Frozen Plasma

Aim. To improve the treatment outcomes of patients with acute bleedings from the upper gastrointestinal tract by improving methods of endoscopic hemostasis and prediction of disease recurrence. Methods. The results of treatment of 776 patients with bleedings from the upper gastrointestinal tract have been analyzed. Methods of conservative therapy, endoscopic hemostasis and surgical treatment were used in combination with infusion therapy. Results. Established was the necessity of a differentiated method of endoscopic hemostasis, depending on the localization of the bleeding source, its intensity and effectiveness during ongoing bleedings. Infusion therapy should be initiated from the moment of verification of the diagnosis of acute bleeding from the upper gastrointestinal tract, regardless of the degree of blood loss, and already in the hospital’s emergency department. In cases of mild bleedings the infusion volume is 800-1000 ml: 80% crystalloids + 20% of colloids. The volume of infusion in moderate blood loss is 1500-2300 ml: 60% crystalloids + 20 colloids % + 20% fresh frozen plasma. The volume of infusion in severe blood loss is 2700 ml and more: 20% of crystalloids + 30% colloids + 30% fresh frozen plasma + 20% erythrocyte mass. Replacement therapy requires careful monitoring of the hemodynamic parameters and infusion load due to the unpredictability of body reactions to blood loss and its replacement. In the absence of an effect of conservative treatment within 6-24 hours an emergency operation is indicated with the choice of an optimal method based on an assessment of the physiological status on a POSSUM scale of assessment. Conclusion. Implementation of substitution therapy, which correlates to the degree of blood loss, critically important in order to eliminate ischemia of the wall of the gastrointestinal tract and prevent recurrence of bleeding; the usage of new approaches to the prediction of recurrent bleedings and improvement of methods of endoscopic haemostasis reduces the frequency of their occurrence, duration of in-hospital stay of patients and postoperative mortality.

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