Critical Care Focus 8: Blood and Blood Transfusion by Helen F. Galley, Helen Galley

By Helen F. Galley, Helen Galley

The most recent quantity within the renowned serious Care concentration sequence discusses problems with specific significance at the in depth care unit. besides its spouse volumes it specializes in present components of discussion and alter, and is meant as an replace for all in depth care staff and trainees.

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Sample text

1 Infectious agents, endotoxin and inflammatory cytokines such as tumour necrosis factor alpha (TNF␣) and interleukin-1 (IL-1) activate coagulation by stimulating the release of tissue factor from monocytes and endothelial cells. Upregulation of tissue factor leads to the formation of thrombin and a fibrin clot. 1–5 The end result may be widespread injury to the vascular endothelium, multi-organ dysfunction, and ultimately death. Protein C is an endogenous protein – a vitamin K-dependent serine protease, which promotes fibrinolysis, whilst inhibiting thrombosis and inflammatory responses.

Intensive Care Med 1998;24:663–72. Baudo F, Caimi TM, de Cataldo F, et al. Antithrombin III (ATIII) replacement therapy in patients with sepsis and/or postsurgical complications: a controlled double-blind, randomized, multi-center study. Intensive Care Med 1998; 24:336–42. Levi M, Middeldorp S, Buller HR. Oral contraceptives and hormonal replacement therapy cause an imbalance in coagulation and fibrinolysis which may explain the increased risk of venous thromboembolism. Cardiovasc Res 1999;41:21–4.

27 Patients were eligible for the trial if they had a known or suspected infection on the basis of clinical data at the time of screening and if they met the following criteria within a 24-hour period: three or more signs of systemic inflammation and sepsis-induced dysfunction of at least one organ or system that lasted no longer than 24 hours. Patients had to begin treatment within 24 hours after meeting the inclusion criteria. Patients were randomly assigned through a centralised randomisation 41 CRITICAL CARE FOCUS: BLOOD AND BLOOD TRANSFUSION centre to receive either activated protein C (drotrecogin alfa activated ) or placebo.

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