J. Koscielny

Mean Maternal Second-Trimester Hemoglobin Concentration and Outcome of Pregnancy: A Population-Based Study

Both anemia and the lack of physiological maternal plasma volume expansion during the second trimester are associated with higher maternal morbidity and poor fetal outcome. Mean hemoglobin levels between the 14th and 30th gestational weeks were calculated in 4985 consecutive pregnant women and were correlated with outcome data of pregnancy. It was found that 9.4% of participants (n = 3959) had normal pregnancy outcome. Mean maternal hemoglobin levels were significantly lower in women with a normal pregnancy (11.96 ± 0.94 g/dL) compared with women who had adverse outcome events (preeclampsia, n = 423, 12.5 ± 1.0 g/dL, P < .0001; early birth, n = 464, 12.2 ± 1.01 g/dL, P < .0001; low birth weight newborn, n = 473, 12.2 ± 1.10 g/dL, P < .0001; intrauterine growth retardation, n = 250, 12.2 ± 1.0 g/dL, P < .0001). The risk for any adverse outcome event was lowest with a mean hemoglobin between 11.0 and 12.0 g/dL (odds ratio, 0.625; 95% confidence interval, 0.43-0.89) and highest between 13.0 and 15.0 g/dL (odds ratio, 2.24; 95% confidence interval, 1.54-3.31). In this population-based study from a community in Western Germany, impaired plasma volume expansion was an independent risk factor for the development of an adverse outcome of pregnancy.

Venous Microembolic Signals Detected in Patients With Cerebral Sinus Thrombosis

BACKGROUND AND PURPOSE We sought to assess the usefulness of the Doppler technique in the monitoring of microembolic signals in the main venous outflow pathways in superior sagittal sinus thrombosis. METHODS Transcranial Doppler ultrasound was performed with a range-gated 2-MHz transducer in 6 patients with superior sagittal sinus thrombosis, in 5 subjects with platelet hyperaggregability, and in 20 healthy volunteers. Emboli monitoring was performed mainly in one distal internal jugular vein for 10 to 15 minutes. RESULTS Three of the six patients (50%) with superior sagittal sinus thrombosis had microemboli. None of the patients with platelet hyperaggregation or healthy volunteers revealed microemboli. CONCLUSIONS Microemboli can be found in superior sagittal sinus thrombosis by Doppler ultrasound. Their prognostic significance remains to be determined.

Administration of Recombinant Activated Factor VII (NovoSeven) in Three Cases of Uncontrolled Bleeding Caused by Disseminated Intravascular Coagulopathy

Recombinant activated factor VII has been used successfully in many cases of traumatic and surgical bleeding complications that were unresponsive to standard treatment. However, because disseminated intravascular coagulation can develop from a thrombin burst as a side effect of recombinant activated factor VII, it is not yet established for bleeding complications induced by disseminated intravascular coagulation. This article presents 3 patients with severe sepsis and fulminant disseminated intravascular coagulation. Excessive microvascular bleeding persisted despite conventional therapy, and surgical intervention and radiologic embolization did not control bleeding. After administration of recombinant activated factor VII, bleeding ceased in all patients, and no overt thromboembolic events occurred. One patient survived to be discharged from the hospital. The other 2 patients died from refractory multiorgan failure and overall poor prognosis. Recombinant factor VIIa might be an option for the treatment of severe bleeding complications in the case of DIC refractory to the conventional therapy.

Consensus use of desmopressin and antifibrinolytics in three university clinics.

Five million operations were carried out in 2400 clinics in Germany in 1996. Perioperative haemorrhage occurred in approximately 10-20% of these operations (1 000 000), of which 75% were surgically related and 25% as a result of disorders of haemostasis. In general, treatment of these haemorrhages mvolved two erythrocyte concentrates (EC), one Gesh Gozen plasma (FFP) and administraaon of thrombocyte concentrates (TC) in every tenth case. This means admirustraaon ofEC in every eighth case, a total of 500 000 EC, an FFP unit in every 16th case, a total of 250 OOO units of FFP. and a T C in every tenth case, a total of 25 000 TC. of haemostasis dependent peri-operative haemorrhaging in Germany. With an average cost of DM13O-150 (65-75 Euro) for EC, DMl00 (50 Euro) for FFP and DM1200 (600 Euro) for TC, a resultant cost is approximately DM125 OOO OOO (62 500 000 Euro) for the use ofblood products for haemostatic dependent pen-operative bleeding alone. Furthermore, the additional cost of approximately DM50 000 000 (25 OOO OOO Euro) for the increased use of antibioacs in the case of transfusion patients, presently three ames greater than patients not requinng transhion, must also be taken into account. Moreover, the potential risk ofinfection of HIV, HBV, HCV and also Lues-infection must be considered. Consequently differential diagnosis and treatment has gained particular Importance in peri-operative bleeding in prosthesis surgery, e.g. knee and hip jomt replacement and in surgery involving high blood loss. It is sensible to identify patients at hgh risk of bleeding prior to surgery and prepare for ths. In particular, identification of coagulopathies (primary or secondary, in particular due to acetyl salicylic acid (ASS), von Willebrand’s disease) is effective in minimising blood loss. Situations such as emergency surgery and acute patients must often be treated rationally without recourse to accurate haemostatic diagnosis. Simple schemes are essential for fast action.

Platelet Function in Platelet Concentrates during Storage: Comparison of Two Blood Cell Separators

Background: In a controlled, randomized, prospective, open, comparative study we evaluated the platelet function of 112 platelet concentrates (PC) prepared by apheresis during 5-day storage. Material and Methods: In one group, 56 PC were prepared by blood cell separator CS-3000 Plus (Baxter GmbH) and the collecting chamber PLT 30™ with the Omnix™ system; in the second group, 56 PC were prepared by blood cell separator AS-104 (Fresenius AG). In order to assess the platelet function of PC, the following parameters have been investigated at the day of donation and after 48-hour and 120-hour storage: platelet reactivity according to the Grotemeyer method, index of platelet aggregation induced by ADP and collagen, respectively, and platelet count. Results: Due to an elevated number of hyperaggregable platelets in PC separated with the CS-3000 Plus, platelet reactivity of PC in case of separation with the CS-3000 Plus was higher (1.46 ± 0.9) compared to that of PC separated with the AS-104 (1.20 ± 0.40; p = 0.064). The collagen-induced platelet aggregation after 48-hour storage was significantly higher in PC obtained by the AS-104 separator compared to that of the CS-3000 Plus device (1.54 ± 0.36 versus 1.45 ± 0.36; p < 0.018). With an increase of 63.7%, the level of ADP-induced aggregation was higher in PC collected with the AS-104 than that found in PC obtained by the CS-3000 Plus (34.3%; p = 0.018). With both methods, ADP-induced aggregation only occurred on the day of donation. In PC prepared by AS-104, the reduction of platelets during 5-day storage was 133 × 103/μl (11%) compared with 294 × 103/μl (21%) in PC generated by the CS-3000 Plus. The volume of PC showed also differences between the two methods. Conclusion: This investigation demonstrates the necessity to define quality characteristics for PC regarding platelet function in order to optimize the separation process.

Diagnostik und Therapie der hämorrhagischen Diathese in der perioperativen Situation

Zusammenfassung Die Differentialdiagnostik und Therapie von perioperativen Blutungen besitzt in der Gefäß- und Kardiochirurgie bei Eingriffen mit hohen Blutverlusten einen besonderen Stellenwert. So ist es sinnvoll, Patienten mit einem erhöhten Blutungsrisiko bereits präoperativ zu erfassen und adäquat vorzubereiten. Insbesondere die präoperative Erfassung von Thrombopathien [medikamenteninduzierte Thrombopathien (insbesondere durch ASS), von-Willebrand-Jürgens-Syndrom, andere angeborene Thrombopathien] ist bei der Minimierung von Blutverlusten effektiv. Nicht elektive Situationen (Blutung bei Notoperationen, Akutpatienten) müssen oft ohne gezielte hämostaseologische Diagnostik rational therapiert werden. Einfache Schemata sind für ein schnelles Handeln unabdingbar. In dieser Arbeit soll versucht werden, Hinweise zu Diagnostik und Therapie der hämorrhagischen Diathese mit den Schwerpunkten: Diagnostik und Therapie der thrombozytär bedingten hämorrhagischen Diathese und Diagnostik und Therapie der plasmatisch bedingten hämorrhagischen Diathese aus hämostaseologisch-transfusionsmedizinischer Sicht zu vermitteln. Ein für den Routinebetrieb auf chirurgischen Stationen anwendbares Schema zur präoperativen Erfassung von Patienten mit erhöhtem Blutungsrisiko sowie erste Erfahrungen damit werden vorgestellt.Abstract In surgical procedures associated with high blood loss, such as vascular and cardiac operations, differential diagnosis and therapy of perioperative hemorrhage are of special importance. Preoperative screening for patients at high risk of bleeding and in particular for those with qualitative platelet disorders [drug-induced platelet disorders (in particular ASS), von Willebrands disease and other congenital platelet disorders] is effective in minimizing blood loss. Bleeding in acute medical emergencies or during emergency operations may require treatment without specific investigations being performed in advance. Therefore, simple schemes are essential for the rapid management of acute hemostatic problems. The aim of this paper was to address the diagnostic and therapy of hemorrhagic diathesis focusing mainly on diagnosis and therapy of hemorrhagic diathesis due to blood platelet disorders and blood coagulation disorders and preoperative identification of patients at increased risk of bleeding.

Autologe Blutkomponentenspende mit dem Programm PES2 des Zellseparators MCS 3p

Hintergrund: Gegenwartig geht der Trend auf dem Gebiet der autologen Blutspende in die Richtung qualitatsverbessernder Masnahmen. Seit Anfang der neunziger Jahre wurde in mehreren t

Rheologische und kapillarmikroskopische Größen zur Diagnostik des von-Willebrand-Jürgens-Syndroms

In future, the capillary microscopy may add to the spectrum of differential diagnosis finding in haemostaseological and angiogical centres as a screening test. Especially the fast and simple observation of the capillary morphology with changes such as capillary dilatations, capillary bleeding (the easiest case, extravasal cells, but also fresh bleeding at the summit of the capillary) and simultaneous findings of torqua-tion of the capillaries seem to be very sensitive for the diagnosis of the von Willebrand-Jurgens syndrome – according to the data collected until now.

Vergleich von zwei 6%igen mittelmolekularen Hydroxyäthylstärkelösungen auf die Eliminationskinetik und die Fließfähigkeit des Blutes bei freiwilligen Probanden

Ziel: Prufung des Einflusses des C2/C6-Besetzungsverhaltnisses und des Substitutionsgrades von zwei 6%igen Hydroxyathylstarke-(HES-)Losungen auf die Eliminationskinetik und die Flui