BACKGROUND: This study was performed to analyze the appropriateness and the efficacy of fresh frozen plasma (FFP) transfusions for the treatment of coagulopathy. METHODS: Three hundred and eleven patients with FFP transfusion histories were evaluated on the state of coagulopathy and the reasons for transfusion. The reasons were classified according to the recommendations by the British Committee for Standards in Haematology (BCSH) for evaluation of transfusion appropriateness. The efficacy of transfusions was evaluated in 144 patients with coagulopathy by means of delta PT (%) and delta aPTT (sec). Corrected delta PT (c delta PT) and corrected delta aPTT (c delta aPTT) were defined as delta PT and delta aPTT divided by the transfusion amount, and these were compared among the disease groups. RESULTS: Forty-two patients (30.5%) were definitely indicated, and 53 patients (17.0%) were conditionally indicated. One hundred and eighty-four patients (59.2%) were transfused with no justification for the transfusions. Of the improved cases, 27.8% of the patients scored at more than 10% in the PT (%) category. In 28.1% of the patients, there were more than 10 sec in aPTT (sec). There was a significant correlation between the volume of the transfusion (mL/kg) and the delta PT and delta aPTT (r=0.2932, P=0.0004; r=0.2379, P=0.0047; respectively). The c delta PT had an inverse correlation to the elapsed time from transfusion to the coagulation assay (r=-0.1815, P=0.0301). The c delta PT and the c delta aPTT were significantly lower in patients with liver disease than those with DIC (P=0.0009, P=0.0084; respectively). CONCLUSIONS: We found that FFP was transfused more inappropriately than should have been. The transfusion volume was the most significant factor for the efficacy of FFP transfusions. FFP transfusions were less efficient in the patients with liver disease.
Blood Transfusion ; Dacarbazine ; Humans ; Liver Diseases ; Plasma*

Humans ; Liver Diseases ; blood ; Plasma ; metabolism ; Proteome

We have 3 more cases of experiences of massive transfusion undergoing hepatobiliary surgery above 20 units of whole blood, packed RBCs, FFP or cryoprecipitate under thrombelastographic guidance and monitoring intraoperatively. One of them had been transfused with 98 units of whole blood and 16 units of PRBC during a couple of times operation without any post-massive transfused pulmonary complications. TEG was originally developed by Hartert in 1948 but its clinical use has been limited. Recently as increases of severe and persistent coagulopathy that accompanies end-stage liver diseases and leads to massive intraoperatve bleeding, minute-to-minute monitoring of the coagulation system is mandatory for successful completion of surgery and for patient survival. Under the condition of our clinical experiences TEG appears to be a very effective method of monitoring blood coagulation. First, blood coagulabilty can be observed rapidly and simply in acute clinical situations within 30 minutes. Second, it assesses the quality of blood clot including the influence of cellular and humoral elements and pathologic conditions. The last, under the reliable guidance of TEG we could facilitate the segmental blood transfusion rather than using whole blood intraoperatively and it is to be a moment of the development of PRBC transfusion set by Kim et al.
Blood Coagulation ; Blood Transfusion ; Hemorrhage ; Humans ; Liver Diseases

Liver function tests (LFT) are helpful screening tools to detect hepatic dysfunction. LFT are further used to categorize hepatic dysfunctions, to estimate the severity of hepatic disease, and for the follow-up of liver diseases. Since liver performs a variety of functions, no single test is sufficient alone to provide complete estimate of function of liver. Effective interpretation of the hepatic function panel requires knowledge of underlying pathophysiology and the characteristics of panel tests. This review includes a classification of liver diseases, which are commonly detected by routine LFT, a list of liver functions with appropriate tests for each function, and a guide to panel interpretation and further laboratory investigation.
Humans ; Liver/enzymology/metabolism/pathology ; Liver Diseases/blood/*diagnosis ; Liver Function Tests

BACKGROUND: The large volume of blood products are required during orthotopic liver transplantation. Any preoperative and intraoperative factors may influence the intraoperative blood products usage. METHODS: We retrospectively reviewed the demographic information, coagulation screens, thrombelastographic variables, and intraoperative blood requirements in 952 adult patients, who underwent orthotopic liver transplantation at the University of Pittsburgh Medical Center between January 1992 and December 1995. A preoperative coagulation abnormality score (CAS) was calculated by assigning one point of each abnormal result of the coagulation tests (PT, aPTT, platelet count) and thrombelastographic variables (reaction time, alpha angle, maximal amplitude, clot lysis index). Intraoperatively, blood products and pharmacologic coagulation therapy were administered based on thrombelastographic and hemodynamic data. RESULTS: Underlying liver disease, retransplantation one month after the first transplantation, poor preoperative coagulation profiles were predictive of intraoperative blood usage. Age, preoperative PT >15 sec, and CAS were not predictive of intraoperative blood usage. The severe fibrinolysis during operation occurred. More blood products were required in patients with severe fibrinolysis. CONCLUSIONS: The understanding of preoperative and intraoperative factors affecting blood product requirements can help the management of blood component therapy during liver transplantation.
Adult ; Blood Platelets ; Fibrinolysis ; Hemodynamics ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Retrospective Studies ; Risk Factors*

Alanine Transaminase ; blood ; Aspartate Aminotransferases ; blood ; Female ; Humans ; Liver ; pathology ; Liver Diseases, Alcoholic ; blood ; diagnosis ; Male ; gamma-Glutamyltransferase ; blood

Animals ; Chronic Disease ; Endotoxemia ; blood ; etiology ; Endotoxins ; blood ; Escherichia coli ; Humans ; Liver Cirrhosis ; blood ; complications ; Liver Diseases ; blood ; complications

Erythrocyte Indices ; Erythrocytes ; Hepacivirus ; Humans ; Liver Diseases ; blood ; virology

BACKGROUND: Liver transplantation (orthotopic) is considered as an important therapy for the end stage liver diseases, but because of the coagulopathies of these patients, the massive bleeding during the operation has been a disturbing problem. So, the role of blood bank has increasingly been important for the appropriate blood products supply for the operation. METHODS: The authors reviewed retrospectively the hospital records of 9 patients who had taken orthotopic liver transplantations (OLT) at the Seoul Paik Hospital from March, 1992 to November, 1994. RESULTS AND CONCLUSION: The mean operation time and hospitalization duration was 14.1 hours and 35.3 days, respectively. Intraoperatively, the operations required a mean of 2.4 units of whole blood (WB), 29.4 of red cells (RBCs), 32.0 of fresh frozen plasma (FFP), 17.5 of platelet concentrates (PLTs), and 4.1 of cryoprecipitates (CRYOs). During the entire hospital stay, a mean of 9.3 units of WB, 56.1 of RBCs, 108.3 of FFP, 210.8 of PLTs, and 5.6 of CRYOs were transfused.
Blood Banks ; Blood Platelets ; Hemorrhage ; Hospital Records ; Hospitalization ; Humans ; Length of Stay ; Liver Diseases ; Liver Transplantation* ; Liver* ; Plasma ; Retrospective Studies ; Seoul

Alanine Transaminase ; blood ; Aspartate Aminotransferases ; blood ; Fatty Liver ; blood ; etiology ; Glucose Tolerance Test ; Humans ; Insulin Resistance ; Leptin ; blood ; Liver Diseases ; blood ; etiology ; Obesity ; blood ; complications ; Risk Factors