血浆在纠正危重症儿童轻度升高的 PT-INR 方面无效：一项回顾性观察研究。
Plasma is ineffective in correcting mildly elevated PT-INR in critically ill children: a retrospective observational study.
机构信息
Department of Pathology and Immunology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA.
Division of Transfusion Medicine and Coagulation, Texas Childrens' Hospital, 6621 Fannin Street, Suite WB 1100, Houston, TX 77030 USA.
出版信息
J Intensive Care. 2014 Nov 29;2(1):64. doi: 10.1186/s40560-014-0064-1. eCollection 2014.
BACKGROUND
Fresh frozen plasma transfusion is widely utilized in pediatric clinical practice to correct mild coagulopathy. Several studies on adult population have shown that transfusion of plasma cannot effectively correct mild coagulopathy when international normalized ratio (INR) is ≤1.5. Much controversy exists about the generalization of this finding for pediatric populations, especially since pediatric dosages often exceed those in adults. The aim of this study is to determine the prevalence of plasma transfusion with mild coagulopathy (INR ≤ 1.5) and its effectiveness in a pediatric setting.
METHODS
In our tertiary referral hospital, we retrospectively reviewed the electronic medical records of all patients who received plasma (April to October 2011) for mildly elevated prothrombin time (PT)-INR levels (≤1.5) and had post-transfusion PT-INR measurements; patients who received intraoperative, ECMO, or plasma exchange-related plasma transfusions were excluded from this study. We abstracted demographic data and pre- and post coagulation test results for the patients included in our study.
RESULTS
Among 468 plasma transfusions administered to 285 patients from April to June 2011, 60 plasma transfusions (12.8%) were given to patients with PT-INR ≤ 1.5 (range 1.3-1.5). Forty-one patients [median age 2.5 years (IQR, 0.14 to 13.75 years), median weight of 16.0 kg (IQR, 8.0 to 69.3 kg)] who received 41 single plasma transfusions [median dose 11 mL/Kg (IQR, 6-15)] had post-transfusion PT-INR measurements and were included in our study. There was no significant difference in their PT-INR values (p = 0.34) pre- and post-transfusion. Of our study, only 15.4% patients showed post-transfusion normalization [median change in PT-INR 0.15 (IQR, 0.1-0.2)] and were not different from the remaining 85% in age, plasma dose, and bleeding status.
CONCLUSIONS
The prevalence of plasma transfusion for correction of mildly elevated PT-INR levels in critically ill children is high (12.8%). Plasma transfusion showed no significant effect in correcting minor prolongation of PT-INR in pediatric patients regardless of age, volume of plasma transfused per kilogram (dosage), or bleeding status.
背景
在儿科临床实践中，新鲜冰冻血浆输注被广泛用于纠正轻度凝血障碍。一些针对成人的研究表明，当国际标准化比值（INR）≤1.5 时，输注血浆并不能有效纠正轻度凝血障碍。对于儿科人群来说，这种发现的推广存在很大争议，尤其是因为儿科的剂量通常超过成人的剂量。本研究旨在确定儿科人群中轻度凝血障碍（INR≤1.5）时进行血浆输注的流行情况及其有效性。
方法
在我们的三级转诊医院，我们回顾性地审查了所有在 2011 年 4 月至 10 月期间因轻度升高的凝血酶原时间（PT）-INR 水平（≤1.5）而接受血浆输注（接受术中、ECMO 或血浆置换相关血浆输注的患者除外）并进行了输注后 PT-INR 测量的患者的电子病历。我们提取了纳入研究的患者的人口统计学数据和凝血前及凝血后检测结果。
结果
在 2011 年 4 月至 6 月期间，468 次血浆输注中有 60 次（12.8%）用于 PT-INR≤1.5（范围 1.3-1.5）的患者。41 名患者[中位年龄 2.5 岁（IQR，0.14 至 13.75 岁），中位体重 16.0 公斤（IQR，8.0 至 69.3 公斤）]接受了 41 次单剂量血浆输注[中位剂量 11 毫升/公斤（IQR，6-15）]，并进行了输注后 PT-INR 测量，包括在我们的研究中。他们的 PT-INR 值在输注前后没有显著差异（p=0.34）。在我们的研究中，只有 15.4%的患者在输注后恢复正常[PT-INR 中位数变化 0.15（IQR，0.1-0.2）]，与其余 85%的患者在年龄、每公斤血浆剂量和出血状态方面没有差异。
结论
在危重症儿童中，为纠正轻度升高的 PT-INR 水平而进行血浆输注的比例很高（12.8%）。无论年龄、每公斤（剂量）输注的血浆量或出血状态如何，血浆输注对纠正儿科患者 PT-INR 轻度延长均无显著影响。
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