Fibrinogen content was determined for each of 50 units of citrate-dextrose-phosphate (CPD)-preserved whole blood, packed red blood cells reconstituted with 250 ml. of saline, and packed red cells reconstituted with 250 ml. of purified plasma protein fraction (PPF). The total protein and albumin were measured, by electrophoresis, on each of 10 units of the three varieties of blood. The fibrinogen content of the two types of reconstituted cells was significantly lower than that of whole blood. Although the total protein/albumin content of whole blood and PPF-reconstituted red cells was similar, saline-reconstituted cells were markedly deficient in both total protein and albumin. Low fibrinogen and platelet levels subsequent to transfusion with reconstituted packed red cells can lead to an erroneous diagnosis of disseminated intravascular coagulation. Administration of large quantities of saline-reconstituted packed cells could be an etiologic factor in postoperative interstitial pulmonary edema.
[Show abstract][Hide abstract] ABSTRACT: Twenty-eight patients undergoing major aortic reconstructions were prospectively randomized into two groups to compare blood replacement with either whole blood (WB) or packed cells (PRBC). Cardiac index (CI), pulmonary capillary wedge pressure (PCWP), intrapulmonary shunt (Qs/Qt), serum colloid osmotic pressure (COP), platelets, prothrombin time (PT), partial thromboplastin time (PTT), and fibrinogen were measured before operation, during operation, and for three days after operation. The postoperative CI increased significantly in both groups from preoperative value, but was not significantly different between the groups. In the PRBC group, there was a significant decrease in postoperative COP and COP-PCWP gradient from preoperative value. This did not occur in the WB group. There was no significant difference between groups in postoperative Qs/Qt, nor was there any evidence of clinical or radiographic pulmonary dysfunction. Both groups manifested a prolongation of the PT and PTT immediately after operation, but these returned to normal without intervention by the first day after operation. It is felt that blood replacement with reconstituted packed red cells can provide effective volume replacement without producing coagulopathy. The decreases observed in COP and COP-PCWP gradient do not result in physiologic or clinical evidence of significant pulmonary dysfunction.
Annals of Surgery 04/1981; 193(3):337-40. DOI:10.1097/00000658-198103000-00015 · 8.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The effect of a 20 % albumin solution on plasma oncotic pressure, renal function and peripheral oedema was investigated in 30 adult patients undergoing elective major abdominal surgery. Half of them received an average of 173 g of albumin between the end of the operation and the 5th postoperative day, in accordance with a standardized scheme. Otherwise the same schedules for fluid therapy and blood replacement were followed in all patients. Postoperatively, serum albumin and plasma oncotic pressure were fairly normal in the albumin group, but decreased by 28 % and 24 % in the control group. The difference between the groups was statistically significant during the first week, but disappeared during the second week. Arm and thigh circumferences increased postoperatively to a similar extent in both groups. There were no apparent differences in circulatory variables, alveolo-arterial oxygen tension difference, incidence of wound infection or postoperative restoration of intestinal activity between the groups. Although renal and thromboembolic complications occurred only in the control group, the material is too small to permit any conclusions to be drawn from the possible difference in renal function and morbidity between the groups. The limited availability and high cost of albumin require strict indications for its use. Our results so far have failed to justify routine administration of concentrated albumin postoperatively.
[Show abstract][Hide abstract] ABSTRACT: The use of a gelatin plasma substitute as an integral part of a unified national program for the procurement of blood components and derivatives paves the way for the extensive use of red cell concentrates in the treatment of hemorrhage, the plasma from the original donations being partly diverted to the fractionation program of a national transfusion service. We estimated the potential of such a system paced by the demand for red cells and predicted that the use of 20% of fresh whole blood and 80% concentrates would not increase the demand for albumin, the yield of which would suffice to cover three-quarters of current needs in our country. The actual performance of a program using 85% of red cell concentrates in a university hospital with an exceptionally high incidence of major hemorrhage was analyzed in detail. The use of albumin per unit of transfused red cells rose by 9%. With a nationwide increase of this magnitude, 67% of the demand in our country could still be met and the estimated true need for albumin of 200 kg per million inhabitants and year would be fully covered. The yield of factor VIII is 200–300% of the demand. The determinants of the effects of such a system vary from country to country, but its fundamental potential is obviously considerable.
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