張循善輸血治療傳統(tǒng)觀念的變革與更新xxxx省醫(yī)學(xué)會(huì)-資料下載頁
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【正文】 包括血友病 A/B）； ※ DIC。 ※ 肝衰竭。 56 Guidelines for the use of freshfrozen plasma British Journal of Haematology 2023。 126:11 ? Single inherited clotting factor deficiencies for which no virussafe fractionated product is available. [ex. Factor V] ? Multifactor deficiencies associated with severe bleeding ( with bleeding) ? Freshfrozen plasma is not indicated in DIC with no evidence of bleeding. ? Hypofibrinogenemia: Cryoprecipitate may be indicated if the plasma fibrinogen is less than 1 g/l, ? TTP: Single volume daily plasma exchange should ideally be begun at presentation (grade A remendation, level Ib evidence) 57 Guidelines for FFP Surgical bleeding: ? Should be guided by timely tests of coagulation ? FFP should never be used as a simple volume relacement in adults or children (grade B remendation, level IIb evidence). ? Massive transfusion: If bleeding continues after large volumes of crystalloid, red cells and platelets have been transfused, FFP and cryoprecipitate may be given so that the PT and APTT ratios are shortened to within , and a fibrinogen concentration of at least g/l in plasma obtained. British Journal of Haematology 2023。 126:11 58 Guidelines for FFP DIC ? Treating the underlying cause is the cornerstone of managing DIC. ? If the patient is bleeding, a bination of FFP, platelets and cryoprecipitate is indicated. ? If there is no bleeding, blood products are not indicated, whatever the results of the laboratory tests, and there is no evidence for prophylaxis with platelets or plasma 59 Guidelines for FFP Liver disease ? Platelet count and function, as well as vascular integrity（完整） , may be more important in these circumstances. ? The response to FFP in liver disease is unpredictable. Complete normalization of the haemostatic defect does not always occur. If FFP is given, coagulation tests should be repeated. ? There is no evidence to substantiate（支持） the practice in many liver units of undertaking liver biopsy only if the PT is within 4 s of the control (grade C remendation, level IV evidence). 60 Improper use of FFP ? Improvement and correction of decreasing the circulating plasma volume ? Nutritional supplementation as the source of protein ? Promotion of wound healing ? Treatment of severe infectious disease,treatment of burn without DIC 61 結(jié)束語 Blood transfusion is a lot like marriage. It should not be entered into lightly, unadvisedly or wantonly, or more often than is absolutely necessary.” Beal, RW, 1976 62 Thank you Q A 63
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