Lu Yao, Sun Guixiang, Liu Xiangfu, Liu Zhiguo, Tan Jianguo, Hao Yiwen, Shan Guiqiu, Luo Qun, Wang Deqing, Xing Yanchao, Zhang Xianqing, Gong Jiwu, Stanworth Simon J, Wang Jun, Wen Aiqing
Department of Blood Transfusion, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China.
Department of Blood Transfusion, Third Affiliated Hospital, Sun Yat-sen University, Guangdong, China.
Transfus Med Rev. 2017 Apr;31(2):107-112. doi: 10.1016/j.tmrv.2016.11.006. Epub 2016 Dec 2.
Patients with cirrhosis used to be associated with frequent use of blood components because of their complex disorder of hemostasis and bleeding complications. Recent findings have indicated that patients with cirrhosis have a state of "rebalanced" or even procoagulant hemostasis and have questioned the prophylactic use of plasma. To evaluate the current status of plasma use in patients with cirrhosis, we conducted a retrospective survey in 11 tertiary-care hospitals in China from September 1 to October 31, 2013. All patients admitted with cirrhosis during the study period were included in the study. The survey collected information including patients' diagnostic and demographic data, clinical course including bleeding complications and invasive procedures, laboratory results, and plasma transfusion data. Among 1595 patients with cirrhosis admitted to the 11 hospitals, 236 (14.8%) patients received 1 or more plasma transfusions during the study period. The number of plasma transfusions is defined as the number of transfusion orders. A total of 1037 plasma transfusions were administered to these patients, with a mean of 4.4 transfusions per transfused patient, ranging from 1 to 22 transfusions per transfused patient. Most plasma transfusions (760/1037; 73.3%) were given to patients without bleeding, for treatment of coagulopathy either without planned invasive procedures (70.4%) or before invasive procedures (2.9%). The median dose of plasma transfusion was 3.8 mL/kg. The rate of plasma transfusion of participating hospitals varied from 5.3% to 31.8%. It is encouraging to see that in one teaching hospital, 85.7% plasma transfusions were given to patients with bleeding indication, showing a promising sign in appropriate transfusion. Prophylaxis or empirical plasma transfusion is still a common problem in managing patients with liver cirrhosis. Wide variations are found in plasma transfusion practice among hospitals. Effective measures to control and reduce empirical correction of abnormal coagulation tests through transfusing plasma should be strengthened urgently.
由于肝硬化患者存在复杂的止血紊乱和出血并发症，过去他们常频繁使用血液成分。最近的研究结果表明，肝硬化患者存在“重新平衡”甚至促凝的止血状态，并对预防性使用血浆提出了质疑。为评估肝硬化患者血浆使用的现状，我们于2013年9月1日至10月31日在中国11家三级医疗机构进行了一项回顾性调查。研究期间所有因肝硬化入院的患者均纳入研究。该调查收集了患者的诊断和人口统计学数据、包括出血并发症和侵入性操作在内的临床病程、实验室检查结果以及血浆输血数据。在这11家医院收治的1595例肝硬化患者中，236例（14.8%）患者在研究期间接受了1次或更多次血浆输注。血浆输注次数定义为输血医嘱的数量。这些患者共接受了1037次血浆输注，每位接受输血的患者平均输血4.4次，每位接受输血的患者输血次数从1次到22次不等。大多数血浆输注（760/1037；73.3%）给予了无出血的患者，用于治疗无计划侵入性操作（70.4%）或侵入性操作前（2.9%）的凝血病。血浆输注的中位剂量为3.8 mL/kg。参与调查医院的血浆输注率从5.3%到31.8%不等。令人鼓舞的是，在一家教学医院，85.7%的血浆输注给予了有出血指征的患者，这在合理输血方面显示出了良好的迹象。预防性或经验性血浆输注在肝硬化患者的管理中仍然是一个常见问题。各医院在血浆输注实践中存在很大差异。应迫切加强有效措施，以控制和减少通过输注血浆对异常凝血试验进行经验性纠正的情况。
