DOCSLIB.ORG

Moderate Glucose Supply Reduces Hemolysis During Systemic Inflammation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Moderate Glucose Supply Reduces Hemolysis During Systemic Inflammation Journal name: Journal of Inflammation Research Article Designation: Original Research Year: 2018 Volume: 11 Journal of Inflammation Research Dovepress Running head verso: Jägers et al Running head recto: Moderate glucose supply reduces hemolysis open access to scientific and medical research DOI: http://dx.doi.org/10.2147/JIR.S155614 Open Access Full Text Article ORIgInal ReseaRch Moderate glucose supply reduces hemolysis during systemic inflammation Johannes Jägers1 Background: Systemic inflammation alters energy metabolism. A sufficient glucose level, stephan Brauckmann2 however, is most important for erythrocytes, since erythrocytes rely on glucose as sole source Michael Kirsch1 of energy. Damage to erythrocytes leads to hemolysis. Both disorders of glucose metabolism Katharina and hemolysis are associated with an increased risk of death. The objective of the study was effenberger-neidnicht1,3 to investigate the impact of intravenous glucose on hemolysis during systemic inflammation. Materials and methods: Systemic inflammation was accomplished in male Wistar rats by 1 Institute of Physiological chemistry, continuous lipopolysaccharide (LPS) infusion (1 mg LPS/kg and h, 300 min). Sham control University hospital essen, essen, germany; 2clinic for anesthesiology group rats received Ringer’s solution. Glucose was supplied moderately (70 mg glucose/kg and and Intensive care, University h) or excessively (210 mg glucose/kg and h) during systemic inflammation. Vital parameters hospital essen, essen, germany; For personal use only. 3Institute of Physiological chemistry, (eg, systemic blood pressure) as well as blood and plasma parameters (eg, concentrations of University hospital essen, essen, glucose, lactate and cell-free hemoglobin, and activity of lactate dehydrogenase) were measured germany hourly. Clot formation was analyzed by thromboelastometry. Results: Continuous infusion of LPS led to a so-called post-aggression syndrome with disturbed electrolyte homeostasis (hypocalcemia, hyperkalemia, and hypernatremia), changes in hemody- namics (tachycardia and hypertension), and a catabolic metabolism (early hyperglycemia, late hypoglycemia, and lactate formation). It induced severe tissue injury (significant increases in plasma concentrations of transaminases and lactate dehydrogenase), alterations in blood coagula- tion (disturbed clot formation), and massive hemolysis. Both moderate and excessive glucose sup- ply reduced LPS-induced increase in systemic blood pressure. Excessive but not moderate glucose supply increased blood glucose level and enhanced tissue injury. Glucose supply did not reduce LPS-induced alterations in coagulation, but significantly reduced hemolysis induced by LPS. Journal of Inflammation Research downloaded from https://www.dovepress.com/ by 54.70.40.11 on 20-Dec-2018 Conclusion: Intravenous glucose infusion can diminish LPS-related changes in hemody- namics, glucose metabolism, and, more interestingly, LPS-induced hemolysis. Since cell-free hemoglobin is known to be a predictor for patient’s survival, a reduction of hemolysis by 35% only by the addition of a small amount of glucose is another step to minimize mortality during systemic inflammation. Keywords: lipopolysaccharide, sepsis, erythrocytes, red blood cells, cell-free hemoglobin, glucose metabolism correspondence: Katharina Introduction effenberger-neidnicht Blood glucose level is tightly regulated in healthy individuals.1,2 In situations of critical Institute of Physiological chemistry, illness (eg, trauma, burn, or systemic inflammation), however, energy metabolism and University hospital essen, hufelandstraße 55, essen D-45122, germany glucose homeostasis are dysregulated.1–6 The metabolic response to injury and sepsis is Tel +49 201 723 4103 often called auto-cannibalism and includes a rapid mobilization of all substrate depots email katharina.effenberger-neidnicht@ uni-due.de (eg, glycogen) and, accordingly, the loss of muscle mass and functional proteins, body submit your manuscript | www.dovepress.com Journal of Inflammation Research 2018:11 87–94 87 Dovepress © 2018 Jägers et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work http://dx.doi.org/10.2147/JIR.S155614 you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Powered by TCPDF (www.tcpdf.org) 1 / 1 Jägers et al Dovepress fat, and the glucose storage.3–7 During systemic inflamma- from AbbVie Deutschland (Ludwigshafen, Germany), ket- tion, higher glucose requirement is covered by both increased amine 10% from Ceva (Düsseldorf, Germany), lidocaine hepatic glycogenolysis and gluconeogenesis leading to an (Xylocaine 1%) from AstraZeneca (Wedel, Germany), medi- initial hyperglycemic state.5,6,8 However, the glycogen depots cal oxygen from Air Liquide (Düsseldorf, Germany), Ringer’s are quickly exhausted after some time in case of higher solution from Fresenius Kabi (Bad Homburg, Germany), glucose consumption. From this moment onward, glucose and 2.0 mL self-filling arterial samplers containing 80 IU supply can only be achieved by an increased gluconeogenesis electrolyte-balanced heparin (PICO50) from Radiometer in the liver (temporary euglycemic phase in metabolic stress Medical (Brønshøj, Denmark). Portex catheters (0.58 mm response).5,6,8 If this possibility of endogenous glucose pro- i.d./0.96 mm o.d.) were obtained from Smith Medical Inter- duction is also restricted or if the glucose uptake rate exceeds national (Grasbrunn, Germany). the rate of glucose production – as it is the case for severe sepsis and inflammation – finally hypoglycemia occurs.5,6,8 animals Clinical studies showed that hypoglycemia or hyperglycemia Male Wistar rats (390–520 g, from Envigo, formerly (defined as malglycemia) is associated with an increased risk Harlan Laboratories, Horst, Netherlands) received human of death.9–12 In situation of critical illness, glucose as energy care according to standards of the Federation of European source for the brain is replaced almost completely by ketone Laboratory Animal Science Association. The experimental bodies.6 Erythrocytes, however, are dependent on glucose procedure was reviewed and approved by the local Animal as the sole source of energy (anaerobic glycolysis),13,14 Care and Use Committee with the permit number Az. even though under catabolic conditions, for a short time, 84-02.04.2013.A015 (Landesamt für Natur, Umwelt und the metabolism of 2,3-diphosphoglycerate to pyruvate and Verbraucherschutz Nordrhein-Westfalen, Recklinghausen, lactate is used for adenosine triphosphate (ATP) synthesis Germany). Rats were kept under standardized conditions of as well.15 “Starved” erythrocytes perish and hemoglobin and temperature (22 ± 1°C), humidity (55 ± 5%), and 12-h/12-h other cytoplasmic components, eg, lactate dehydrogenase light/dark cycles (06:00 a.m. light on/06:00 p.m. light off, For personal use only. and potassium, are released (so-called hemolysis).14 Cell-free standard time) with free access to food (ssniff-Spezialdiäten, hemoglobin and heme can contribute to organ dysfunction Soest, Germany) and water. and death;16–19 the pathologic mechanisms include nitric oxide (NO) consumption and local vasoconstriction, oxida- anesthesia, analgesia and surgical tive injury to lipid membranes, activation of the transcription procedure factor NF-κB, endothelial injury, as well as iron-driven oxida- Rats were anesthetized with isoflurane and received ket- tive inhibition of glucose metabolism.19–22 Thus, hemolysis amine and lidocaine for analgesia as already described.30 can act as a kind of amplifier of the complex response to an Afterwards, catheters were inserted in femoral artery and infection or injury23,24 and worsen the outcome in patients vein and perfused with Ringer’s solution to maintain the with sepsis or trauma.16–19 In contrast to other studies, glucose functionality of the catheters. At the end of the experiment, 9,25,26 Journal of Inflammation Research downloaded from https://www.dovepress.com/ by 54.70.40.11 on 20-Dec-2018 balance was not performed via insulin treatment, but via animals were sacrificed by cardiac incision under deep iso- exogenous glucose supply.27–29 Blood glucose level should be flurane anesthesia. kept high, especially during hypoglycemia, and consequences such as hemolysis through glucose depletion in erythrocytes experimental groups should be avoided. Experiments were performed with overall 40 rats. Sham control In the present manuscript we wanted to investigate group rats received Ringer’s solution at a rate of 7 mL/kg and whether lipopolysaccharide (LPS)-induced hemolysis can h over a total period of 300 min. Systemic inflammation was be prevented or reduced if more glucose was present as a accomplished by continuous LPS infusion over a total period substrate for erythrocytes. of 300 min. Glucose was supplied either moderately or exces- sively during systemic inflammation simultaneously with the Materials and methods LPS infusion. During moderate glucose supply, rats received chemicals and materials LPS in
Load more

Recommended publications
  • The Use of Total Thrombus Formation Analysis System As a Tool to Assess Platelet Function in Bleeding and Thrombosis Risk—A Systematic Review
    International Journal of Molecular Sciences Review The Use of Total Thrombus Formation Analysis System as a Tool to Assess Platelet Function in Bleeding and Thrombosis Risk—A Systematic Review Joanna Sikora 1,*,† , Aleksandra Karczmarska-Wódzka 1,†, Joanna Bugieda 1 and Przemysław Sobczak 2 1 Research and Education Unit for Experimental Biotechnology, Department of Transplantology and General Surgery, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toru´n, 85-094 Bydgoszcz, Poland; [email protected] (A.K.-W.); [email protected] (J.B.) 2 Department of Hematology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toru´n, 85-094 Bydgoszcz, Poland; [email protected] * Correspondence: [email protected]; Tel.: +48-52-585-59-76; Fax: +48-52-585-43-80 † These authors contributed equally to this work. Abstract: Background. Today there are many devices that can be used to study blood clotting disorders by identifying abnormalities in blood platelets. The Total Thrombus Formation Analysis System is an automated microchip flow chamber system that is used for the quantitative analysis of clot formation under blood flow conditions. For several years, researchers have been using a tool to analyse various clinical situations of patients to identify the properties and biochemical processes occurring within platelets and their microenvironment. Methods. An investigation of recent published literature was conducted based on PRISMA. This review includes 52 science papers directly related to the use of the Total Clot Formation Analysis System in relation to bleeding, Citation: Sikora, J.; Karczmarska- surgery, platelet function assessment, anticoagulation monitoring, von Willebrand factor and others.
    [Show full text]
  • Thromboelastometry: Studying Hemostatic Profile in Small for Gestational Age Neonates—A Pilot Observational Study
    European Journal of Pediatrics (2019) 178:551–557 https://doi.org/10.1007/s00431-019-03331-w ORIGINAL ARTICLE Thromboelastometry: studying hemostatic profile in small for gestational age neonates—a pilot observational study Rozeta Sokou1 & Aikaterini Konstantinidi1 & Charikleia Stefanaki1 & Andreas G. Tsantes2 & Stavroula Parastatidou1 & Katerina Lampropoulou1 & George Katsaras1 & Evagelia Tavoulari1 & Nicoletta Iacovidou3 & Elias Kyriakou2 & Antonios Gounaris4 & Stefanos Bonovas5,6 & Argirios E. Tsantes2 Received: 30 November 2018 /Revised: 24 January 2019 /Accepted: 25 January 2019 /Published online: 1 February 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Scarce data exists about the hemostatic status of small for gestational age (SGA) neonates. We aimed at evaluating the hemostatic profile of SGA neonates, using thromboelastometry (TEM). This is an observational study performed in a Greek tertiary General Hospital during an 18-month period. Ninety-three neonates were included in the study: 48 appropriate for gestational age weight (AGA) neonates and 45 SGA neonates Extrinsically activated TEM (ex-TEM) parameters, such as clotting time, clot formation time, amplituderecordedat5and10min,aangle,maximumclot firmness, lysis index at 60 min, and also platelet count, were used for the evaluation of the hemostatic profile in all neonates. No statistically significant differences were noticed regarding all ex-TEM parameters between AGA and SGA neonates, while no event of hemorrhage or thrombosis was noticed in the study population. Conclusions: The coagulation system of SGA neonates seems to be fully functional, with no evident tendency toward coagulopathy or thrombosis, when compared with AGA neonates. TEM seems to provide a promising and valid assessment of coagulation and fibrinolysis systems and may be used as a valuable biomarker, in the future.
    [Show full text]
  • Rotational Thrombo Elastometry and Standard Coagulation Tests For
    a & hesi C st lin e ic n a l A f R Bedawy et al., J Anesth Clin Res 2012, 3:9 o e l s e a Journal of Anesthesia & Clinical DOI: 10.4172/2155-6148.1000243 a n r r c u h o J ISSN: 2155-6148 Research Research Article Open Access Rotational Thrombo Elastometry and Standard Coagulation Tests for Hepatic Patients undergoing Major Liver Resection Ahmed A Bedawy2, Nirmeen A Fayed1, Wesam Morad3, Said Madany2, Fawzy Nematalah2 and Khaled A Yassen1* 1Department of Anaesthesia, Liver Institute, Menoufiya University, Egypt 2Department of Anaesthesia, Alexandria University, Egypt 3Department of Community Health, Liver Institute, Menoufiya University, Egypt Abstract Background: Coagulopathy can associate right hepatotomy in cirrhotic patients. Methods: 20 cirrhotic patients were prospectively studied for 10 days with rotational thromboelastometry (ROTEM) and standard coagulation tests (SCTs). EXTEM and INTEM of ROTEM represent extrinsic and intrinsic coagulation pathways respectively. FIBTEM (ROTEM) represents fibrinogen activity. SCTS include Prothrombin time (PT), activated partial thromboplastin time (aPPT), fibrinogen and platelets. Results: Age and body mass index were 55.9 ± 6.9 years and 23.7 ± 3.1 Kg/m2. Males: Female (11:9). ROTEM parameters were normal except for a prolonged clotting time (CT) on day 1 and 3, associated with a normal clotting formation time (CFT). CT and PT were maximum on day 1 (86.25+15.7 mm and 17.2 ± 2.2 sec, p<0.05, respectively). CT and CFT (EXTEM) were not in correlation with PT (r=-0.29, r=-0.01, p>0.05 respectively). CT and CFT of (INTEM) were also not in correlation with aPTT (r=0.16, r=0.21, p>0.05 respectively).
    [Show full text]
  • Hemorrhage and Thrombosis with Different LVAD Technologies: a Matter of Flow?
    Featured Article Hemorrhage and thrombosis with different LVAD technologies: a matter of flow? Vincenzo Tarzia1, Edward Buratto1,2, Giacomo Bortolussi1, Michele Gallo1, Jonida Bejko1, Roberto Bianco1, Tomaso Bottio1, Gino Gerosa1 1Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy; 2Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Melbourne, Australia Correspondence to: Vincenzo Tarzia, MD. Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128 Padova, Italy. Email: [email protected]. Background: Much of the morbidity and mortality associated with ventricular assist devices (VADs) is due to haemorrhagic and thrombotic complications. To manage antithrombotic therapy, interactions between the patient and pump should be better understood. Methods: We have compared the Jarvik 2000, an axial flow left ventricular assist device (LVAD), with the HeartWare ventricular assist device (HVAD) centrifugal pump, regarding conventional laboratory findings, thromboelastometric and aggregometric tests. Results: Patients with the Jarvik 2000 experienced a significant reduction in platelet count following implantation, a phenomenon not seen with the HeartWare model. Conversely, we observed that levels of platelet activation, as assessed by a platelet function analyzer, and activation of the coagulation system, as assessed by thromboelastometry, were significantly greater in the HeartWare group. Conclusions: It seems that axial flow pumps, being more destructive on blood cells, tend to reduce platelet numbers. On the other hand, centrifugal flow is associated with a hypercoagulable state, possibly resulting from the activation of the coagulation system in the absence of platelet destruction. Keywords: Ventricular assist device (VAD); bleeding; thrombosis; axial flow; centrifugal flow Submitted Apr 04, 2014.
    [Show full text]
  • Rotational Thromboelastometry and Standard Coagulation Tests for Live Liver Donors
    © 2013 John Wiley & Sons A/S. Clin Transplant 2013 DOI: 10.1111/ctr.12067 Rotational thromboelastometry and standard coagulation tests for live liver donors Mohammed M, Fayed N, Hassanen A, Ahmed F, Mourad W, El Maged Mohammeda, Nirmeen Sheikh M, Abofetouh F, Yassen K, Khalil M, Marwan I, Tanaka K. Fayedb, Ashraf Hassanenb, Fatma Rotational thromboelastometry and standard coagulation tests for Ahmedb, Wessam Mouradc, Maha live liver donors. El Sheikhb, Fawzia Abofetouha, Khaled Yassenb, Magdy Khalilb, Abstract: Purpose: To study coagulation of live liver donors with Ibrahim Marwand and Koichio standard coagulation tests (SCT) and rotational thromboelastometry Tanakad (ROTEM) and investigate their relationship. a Methods: A descriptive prospective study involving 50 right hepatotomy Department of Anaesthesia, Cairo University, b donors with epidural catheters. ROTEM (EXTEM, INTEM, and Cairo, Department of Anaesthesia, Liver FIBTEM represent extrinsic and intrinsic pathways of coagulation and Institute, Menoufiya University, Shebeen El c fibrinogen activity, respectively) was measured perioperatively and on Kom, Department of Community Medicine days 1, 3, 5, 10, and 30. SCTs include prothrombin time (PT), and Statistics, Liver Institute, Menoufiya d international normalized ratio (INR) of PT, activated partial University and Department of Surgery, Liver thromboplastin time (aPPT), fibrinogen, and platelets. Institute, Menoufiya University, Shebeen El Results: PT and INR reflect hypocoagulability reaching maximum on Kom, Egypt day one (16.9 Æ 2.5 s, 1.4 Æ 0.2, p < 0.05 compared with baseline). ROTEM was in normal ranges till day 30 with no hypercoagulability. Key words: coagulation – live donors – liver Fibrinogen showed no correlation with maximum clot firmness (MCF) of resection – rotational thromboelastometry FIBTEM (r = 0.35, p > 0.05).
    [Show full text]
  • Evaluation of Hemostasis in Hyperthyroid Cats Audrey E
    Evaluation of hemostasis in hyperthyroid cats Audrey E. Keebaugh Thesis submitted to the faculty of the Virginia Polytechnic Institute and State University in partial fulfillment of the requirements for the degree of Master of Science In Biomedical Veterinary Sciences Stefanie DeMonaco David Panciera Jonathan Abbott Katie Boes June 12, 2020 Blacksburg, VA Keywords: hyperthyroid, hemostasis, hypercoagulability, thromboembolism Evaluation of hemostasis in hyperthyroid cats Audrey E. Keebaugh ABSTRACT Background: Hyperthyroid cats are predisposed to thrombus formation. The mechanism for thrombogenesis is currently unknown, but could be associated with altered hemostasis as seen in hyperthyroid humans. Objective: The purpose of this study was to evaluate markers of hemostasis in hyperthyroid cats compared to healthy cats, and in hyperthyroid cats before and after treatments with radioactive iodine (RIT). Methods: Twenty-five cats with hyperthyroidism and 13 healthy euthyroid cats > 8 years of age were studied. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, antithrombin (AT), D-dimers, thrombin-antithrombin complexes (TAT), von Willebrand Factor antigen (vWF:Ag), and activity of factors VIII and IX were measured. An echocardiogram was performed in all cats and healthy cats with abnormal echocardiograms were excluded. Measurements of hemostasis were evaluated again in 7 cats > 6 months after RIT and deemed to have restored euthyroid status. Results: There is a significant likelihood of being in hypercoagulable state based on hyperthyroid state (P = 0.019) and serum T4 level is significantly associated with predicating hypercoagulability (P = 0.043). Hyperthyroidism is associated with significantly higher median fibrinogen concentration (P < 0.0001), higher median AT activity (P < 0.0001), and higher median vWF:Ag level (P = 0.01) with all values decreasing significantly post-RIT.
    [Show full text]
  • Correlation of Plasma Coagulation Tests and Fibrinogenclauss with Rotational Thromboelastometry Parameters and Prediction of Bleeding in Dogs
    Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2019 Correlation of plasma coagulation tests and fibrinogen Clauss with rotational thromboelastometry parameters and prediction of bleeding in dogs Enk, Nathalie M ; Kutter, Annette P N ; Kümmerle-Fraune, Claudia ; Sigrist, Nadja Abstract: BACKGROUND: Correlation of plasma fibrinogen concentration (fibrinogenClauss ) with rota- tional thromboelastometry (ROTEM) parameters has not been investigated in dogs. OBJECTIVES: To determine the correlation between plasma coagulation tests and fibrinogenClauss with ROTEM parame- ters and to evaluate their ability to predict bleeding in dogs. ANIMALS: Ninety-seven dogs with concur- rent determination of fibrinogenClauss and fibrin polymerization test (FIBTEM) analysis. METHODS: Signalment, pretreatment, clinical signs of bleeding, fibrinogenClauss , plasma coagulation test results, hematocrit, platelet count, FIBTEM, extrinsic (EXTEM) and intrinsic (INTEM) activated ROTEM as- says were retrieved retrospectively. Correlations between fibrinogenClauss and FIBTEM maximum clot firmness (MCFFIBTEM ) and between prothrombin time (PT) or activated partial thromboplastin time (aPTT) and ROTEM parameters were determined. Dogs were further assigned to groups with or with- out clinical signs of bleeding. The prognostic significance of significantly different parameters to predict bleeding was evaluated. RESULTS: FibrinogenClauss showed strong correlation with MCFFIBTEM (r = 0.860, n = 97, P < .001). PT showed strong correlation with EXTEM clotting time (CTEXTEM ) (r = 0.839, n = 53, P < .001), and aPTT was strongly correlated with INTEM CT (CTINTEM ) (r = 0.664, n = 31, P < .001). Platelet count, PT/aPTT, EXTEM clot formation time (CFTEXTEM ), MCFEXTEM , EXTEM maximum clot elasticity (MCEEXTEM ), and CTINTEM were significantly different between groups. A CTINTEM >149 seconds was 100% sensitive to detect bleeding.
    [Show full text]
  • Rotational Thromboelastometry (ROTEM) 24 Hours Post Liver Transplantation Predicts Early Allograft Dysfunction
    Postoperative ROTEM predicts graft dysfunction Romanian Journal of Anaesthesia and Intensive Care 2018 Vol 25 No 2, 117-122 ORIGINAL ARTICLE DOI: http://dx.doi.org/10.21454/rjaic.7518.252.tms Rotational thromboelastometry (ROTEM) 24 hours post liver transplantation predicts early allograft dysfunction Dana Tomescu1,2, Mihai Popescu1,2, Simona Olimpia Dima3 1 Fundeni Clinical Institute, Department of Anaesthesia and Critical Care, Bucharest, Romania 2 “Carol Davila” University of Medicine and Pharmacy, Department of Anaesthesia and Critical Care 3 Fundeni Clinical Institute, “Dan Setlacec” Center for General Surgery and Liver Transplantation, Bucharest, Romania Abstract Early allograft dysfunction (EAD) represents one of the most common and serious complications after liver transplantation (LT). Methods. One hundred sixty-four patients who underwent LT were prospectively included in the present study. Patient demographics, intraoperative blood loss and transfusion were recorded at the time of LT. Lactate levels were recorded during surgery and daily for the first 3 postoperative days. Standard and derived rotational thromboelastometry (ROTEM) parameters were recorded 24 hours after LT. EAD was diagnosed according to Nanashima criteria and post anaesthesia care unit length of stay was recorded. Results. Forty-seven patients (28.6%) developed EAD. Intraoperative blood loss (p = 0.01), packed red blood cells (p = 0.04) and fresh frozen plasma (p = 0.01) transfusion represented intraoperative risk factors for EAD. Lactate levels were significantly higher in patients with EAD at all time points. Patients with EAD demonstrated an increased clot formation time and decreased maximum clot firmness in both intrinsically (p < 0.01) and extrinsically (p < 0.01) activated assay, a decreased thrombin potential index (p < 0.01), area under the curve (p < 0.01) and clot elasticity (p < 0.01) on ROTEM assay.
    [Show full text]
  • ROTEM Analysis
    Introduction In this text, the basis of ROTEM® analysis is described together with its use during the management of acute bleeding. The management of acute bleeding is a complex challenge. Little that is done in this area is fulfilling the hard criteria of evidence based medicine. The recommendations in this compendium are based on the experience of the authors and on the discussion with centres, which use the ROTEM® system in clinical routine. However, these recommendations have not yet been prospectively validated. Causes of Haemostasis Disorders Haemostasis disorders can have several causes. Rather chronic processes (such as comorbidities of the haemostasis-related organs liver - kidney - bone marrow) or hereditary diseases can be differentiated from more acute alterations due to trauma, haemodilution and the current treatment. The resulting alterations affect the plasmatic coagulation factors, platelets and the fibrinolytic system. Bleeding most frequently occurs during and after surgical interventions or traumas, i.e. in situations where trauma and secondary alterations (e.g. due to haemodilution) are added to the disposition of the patient. During such complex haemostasis disorders, the clinical significance of the routine parameters PT, aPTT and platelet count is rather weak. This leads to the interest in laboratory methods, which better reflect haemostasis during these complex processes. A. Calatzis, W. Schramm, M. Spannagl. Management of Bleeding in Surgery and Intensive Care. I. Scharrer / W. Schramm (Ed.), 31 st Hemophilia Symposium Hamburg 2000, Springer Verlag Berlin Heidelberg 2002. Guide ROTEM® Analysis - 09-2016 2 Alterations of haemostatic causes Trauma and coagulopathy as a cause of bleeding 3 Guide ROTEM® Analysis - 09-2016 Thromboelastometry Dr.
    [Show full text]
  • Best Practices in the Management of Traumatic Brain Injury
    ACS TQIP BEST PRACTICES IN THE MANAGEMENT OF TRAUMATIC BRAIN INJURY Released January 2015 Table of Contents Introduction ............................................................................................... 3 Using the Glasgow Coma Scale ...................................................................... 3 Triage and Transport .................................................................................... 5 Goals of Treatment ...................................................................................... 5 Intracranial Pressure Monitoring ..................................................................... 6 Management of Intracranial Hypertension ....................................................... 9 Advanced Neuromonitoring .........................................................................12 Surgical Management .................................................................................13 Nutritional Support ....................................................................................14 Tracheostomy ............................................................................................15 Timing of Secondary Procedures ...................................................................15 Timing of Pharmacologic Venous Thromboembolism Prophylaxis ........................17 Management Considerations for Pediatric Patients with TBI ................................18 Management Considerations for Elderly Patients with TBI ...................................19 Prognostic Decision-Making
    [Show full text]
  • Anesthetic Management of a Chronic
    Anesth Pain Med 2018;13:419-422 https://doi.org/10.17085/apm.2018.13.4.419 Case Report pISSN 1975-5171ㆍeISSN 2383-7977 Anesthetic management of a chronic liver disease patient with very low platelet counts by considering a rebalanced hemostasis - A case report - Received February 14, 2018 Bobae Han, Suk Young Lee, and Gaab-Soo Kim Revised ‌1st, July 2, 2018 2nd, July 12, 2018 Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Accepted July 13, 2018 Sungkyunkwan University School of Medicine, Seoul, Korea The coagulation profile of patients with end-stage liver disease (ESLD) is different from that of healthy individuals. Because hemostasis is rebalanced in chronic liver disease, prophylactic transfusion of blood products may be not necessary for these patients even if they show severe coagulation dysfunction in conventional coagulation results. A Corresponding author 44-year-old man with hepatocellular carcinoma, cholangiocarcinoma and liver cirrhosis Gaab-Soo Kim, M.D., Ph.D. was scheduled for extra-hepatic mass excision under general anesthesia. His preopera- Department of Anesthesiology and tive tests showed severe thrombocytopenia 19 × 109/L. The patient underwent extra- Pain Medicine, Samsung Medical Center, Sungkyunkwan University hepatic mass excision surgery under general anesthesia without transfusion of blood School of Medicine, 81 Irwon-ro, products. The post-operative course was uneventful without requiring any further hemo- Gangnam-gu, Seoul 06351, Korea static therapy. In this case report, we focus on the concept of rebalanced hemostasis in Tel: 82-2-3410-0360 ESLD, and coagulation management based on rotational thromboelastometry. Fax: 82-2-3410-0361 E-mail: [email protected] ORCID Keywords: Blood coagulation; Blood platelets; Rebalanced hemostasis; Rotational http://orcid.org/0000-0002-9383-2652 thromboelastometry; Thromboelastography.
    [Show full text]
  • Thromboelastometry Identifies Coagulopathy Associated with Liver Israelita Albert Einstein - São Paulo (SP), Brasil
    RELATO DE CASO Tomaz Crochemore1 , Felício Aragão Savioli1 , João Carlos de Campos Guerra2, Erika Maria do A tromboelastometria identifica coagulopatia Nascimento Kalmar3 associada à insuficiência hepática e coagulação intravascular disseminada causadas por febre amarela, orientando a terapia hemostática específica: um relato de caso 1. Medicina Intensiva, Hospital Leforte - São Paulo (SP), Brasil. 2.Centro de Hematologia e Laboratório, Hospital Thromboelastometry identifies coagulopathy associated with liver Israelita Albert Einstein - São Paulo (SP), Brasil. 3.Infectologia, Hospital Israelita Albert Einstein - failure and disseminated intravascular coagulation caused by São Paulo (SP), Brasil. yellow fever, guiding specific hemostatic therapy: a case report RESUMO tromboelastometria identificou o distúrbio de coagulação específico e, assim, orientou Este relato de caso detalha um caso grave o tratamento hemostático. Administraram- de febre amarela complicada por insuficiência se concentrados de fibrinogênio e vitamina hepática e coagulação intravascular K, não sendo necessária a transfusão disseminada. A tromboelastometria de qualquer componente do sangue, foi capaz de identificar os distúrbios mesmo na presença de trombocitopenia. da coagulação e orientar o tratamento A tromboelastometria permitiu a hemostático. Relatamos o caso de um identificação precoce da coagulopatia e homem com 23 anos de idade admitido ajudou a orientar a terapêutica hemostática. na unidade de terapia intensiva com A administração de fármacos hemostáticos, quadro com início abrupto de febre e incluindo concentrados de fibrinogênio dor muscular generalizada associados e vitamina K, melhorou os parâmetros a insuficiência hepática e coagulação tromboelastométricos, com correção do intravascular disseminada. Os resultados transtorno da coagulação. Não se realizou dos exames laboratoriais convencionais transfusão de hemocomponentes, e não revelaram trombocitopenia, enquanto a ocorreu qualquer sangramento.
    [Show full text]