Fresh Frozen Plasma as a Successful Antidotal Supplement in Acute Organophosphate Poisoning

Despite improvements to intensive care management and specific pharmacological treatments (atropine, oxime, diazepam), the mortality associated with organophosphate (OP) poisoning has not substantially decreased. The objective of this examination was to describe the role of fresh frozen plasma (FFP) in acute OP poisoning. After a deliberate ingestion of malathion, a 55-year-old male suffering from miosis, somnolence, bradycardia, muscular fasciculations, rales on auscultation, respiratory insufficiency, as well as from an inhibition of red blood cell acetylcholinesterase (AChE) and plasma butyrylcholinesterase (BuChE), was admitted to hospital. Malathion was confirmed in a concentration of 18.01 mg L-1. Apart from supportive measures (including mechanical ventilation for four days), antidotal treatment with atropine, oxime - pralidoxime methylsulphate (ContrathionR), and diazepam was administered, along with FFP. The potentially beneficial effects of FFP therapy included a prompt increase of BuChE activity (from 926 IU L-1 to 3277 IU L-1; reference range from 7000 IU L-1 to 19000 IU L-1) and a reduction in the malathion concentration, followed by clinical recovery. Due to BuChE replacement, albumin content, and volume restitution, FFP treatment may be used as an alternative approach in patients with acute OP poisoning, especially when oximes are not available.

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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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ORGANOPHOSPHATE POISONING

International Journal of Advanced Research ◽

10.21474/ijar01/12284 ◽

2021 ◽

Vol 9 (01) ◽

pp. 122-126

Author(s):

Ravi Jindal ◽

◽

Harinder Pal Singh ◽

Jaspreet Singh ◽

Navjot Kaur ◽

...

Keyword(s):

Organophosphorus Compounds ◽

Fresh Frozen Plasma ◽

Final Outcome ◽

Organophosphate Poisoning ◽

Early Management ◽

Fresh Frozen ◽

Frozen Plasma

Organophosphorus compounds are very commonly available substance especially in agriculture based countries. Its use as a suicidal agent is rampant. Early management of the patient is critical in the final outcome. Use of atropine forms the mainstay of management after early decontamination. The role of oximes has been a matter of controversy. Use of Fresh Frozen Plasma and monitoring the patient using cholinesterase levels is amongst one of the developments in the management of the patient.

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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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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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Role of fresh frozen plasma infusion in correction of coagulopathy of chronic liver disease: a dual phase study

The American Journal of Gastroenterology ◽

10.1111/j.1572-0241.2003.07467.x ◽

2003 ◽

Vol 98 (6) ◽

pp. 1391-1394 ◽

Cited By ~ 133

Author(s):

Wael I. Youssef ◽

Fernando Salazar ◽

Srinivasan Dasarathy ◽

Timothy Beddow ◽

Kevin Daniel Mullen

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Fresh Frozen Plasma ◽

Chronic Liver ◽

Dual Phase ◽

Plasma Infusion ◽

Phase Study ◽

Fresh Frozen ◽

Frozen Plasma

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Role of fresh-frozen plasma in angioedema

European Journal of Emergency Medicine ◽

10.1097/mej.0b013e328360d8b6 ◽

2013 ◽

Vol 20 (4) ◽

pp. 292-293 ◽

Cited By ~ 1

Author(s):

Subramanian Senthilkumaran ◽

Suresh S. David ◽

Ritesh G. Menezes ◽

Ponniah Thirumalaikolundusubramanian

Keyword(s):

Fresh Frozen Plasma ◽

Fresh Frozen ◽

Frozen Plasma

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Bioscavenger therapy for organophosphate poisoning – an open-labeled pilot randomized trial comparing fresh frozen plasma or albumin with saline in acute organophosphate poisoning in humans

Clinical Toxicology ◽

10.3109/15563650.2010.518970 ◽

2010 ◽

Vol 48 (8) ◽

pp. 813-819 ◽

Cited By ~ 14

Author(s):

Kishore Pichamuthu ◽

Jayakumar Jerobin ◽

Anupama Nair ◽

George John ◽

Joseph Kamalesh ◽

...

Keyword(s):

Randomized Trial ◽

Fresh Frozen Plasma ◽

Organophosphate Poisoning ◽

Fresh Frozen ◽

Frozen Plasma

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Is heparin administration necessary during induction chemotherapy for patients with acute promyelocytic leukemia?

Blood ◽

10.1182/blood.v69.1.187.bloodjournal691187 ◽

1987 ◽

Vol 69 (1) ◽

pp. 187-191 ◽

Cited By ~ 2

Author(s):

MA Goldberg ◽

D Ginsburg ◽

RJ Mayer ◽

RM Stone ◽

M Maguire ◽

...

Keyword(s):

Complete Remission ◽

Acute Promyelocytic Leukemia ◽

Induction Chemotherapy ◽

Fresh Frozen Plasma ◽

Promyelocytic Leukemia ◽

Heparin Administration ◽

Fresh Frozen ◽

Thrombotic Complications ◽

Frozen Plasma

The role of heparin in the treatment of the disseminated intravascular coagulation (DIC) associated with acute promyelocytic leukemia (APL) remains unclear. Between 1974 and 1985, we treated 27 patients with APL using four different chemotherapeutic regimens; 23/27 (85%) had evidence of DIC either at presentation or following the initiation of induction chemotherapy. The coagulopathy was treated primarily with fresh frozen plasma and platelet transfusions; only 2/27 (7%) patients received heparin. Twenty of 27 patients (74%) entered complete remission. Major bleeding or thrombotic complications occurred in 5/27 patients (19%), but 2 of these 5 patients presented after hemorrhage had already occurred. None of the 5 patients with bleeding or thrombosis entered complete remission. All of the hemorrhagic complications due to DIC in our study occurred before 1979, which may reflect changes in the management of leukemic patients. This observation emphasizes the risks inherent in the use of historical controls in this population. In conclusion the DIC associated with APL can be successfully treated with intensive blood product support without the use of heparin.

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