Download Critical Care Focus 8. Blood and Blood Transfusion by Helen F. Galley, Helen Galley PDF

By Helen F. Galley, Helen Galley

The most recent quantity within the renowned severe Care concentration sequence discusses problems with specific value at the in depth care unit. besides its spouse volumes it makes a speciality of present components of discussion and alter, and is meant as an replace for all extensive care employees and trainees.

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Extra info for Critical Care Focus 8. Blood and Blood Transfusion

Example text

Combination of antibiotic treatment with the thrombin inhibitor recombinant hirudin for the therapy of experimental Klebsiella pneumoniae sepsis. Thromb Haemost 1994;71:768–72. Levi M, Cromheecke ME, de Jonge E, et al. Pharmacological strategies to decrease excessive blood loss in cardiac surgery:a meta-analysis of clinically relevant endpoints. Lancet 1999;354:1940–7. Boshkov LK, Warkentin TE, Hayward CP, Andrew M, Kelton JG. Heparininduced thrombocytopenia and thrombosis. Br J Haematol 1993;84:322–8.

Removal of precipitating causes such as intravenous broad-spectrum antibiotics or in the case of the obstetric patient, evacuation of the uterus, are paramount. Obviously other exacerbating factors which may make the bleeding worse, particularly hypoxia, acidosis, hypothermia, etc. should be corrected. 29 CRITICAL CARE FOCUS: BLOOD AND BLOOD TRANSFUSION Heparin therapy In my experience the benefits of heparin therapy are exceedingly limited and the risks of exacerbating the bleeding certainly outweigh any potential therapeutic benefit.

7 Heparin therapy also lowers antithrombin by about 5% itself. Antithrombin III (ATIII) concentrate has been available for at least the last ten years in the UK and it is potentially useful in sepsis and DIC. 4 Mortality in the ICU was non-significantly reduced in the ATIII group. Five years later, Eisele and colleagues5 randomised 120 patients admitted to the ICU with an ATIII concentration Ͻ70% of normal to receive ATIII or placebo treatment for 5 days. KaplanMeier analysis showed no difference in overall survival between the two groups: 50% and 46% for ATIII and placebo, respectively.

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