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Biomedical subjects

B Tschirren

Publications and source records attributed to B Tschirren.

At least 19 recordsLinked to original sources
PubMed1984

Antithrombin III and related parameters in surgical patients receiving blood components.

We examined the intra- and postoperative behavior of antithrombin III (AT), factor V, VIII, and fibrinogen in 27 elective surgical patients without evidence of disseminated intravascular coagulation (DIC) and treated according to the concept of blood component therapy inaugurated at our hospital in 1975. The intraoperative depletions of AT and fibrinogen were proportional to the transfusion volumes and correlated significantly. AT, fibrinogen, and especially factor V and VIII were significantly mobilized during surgery. A greater intraoperative depletion of AT was significantly associated with a faster recovery during the first 24 postoperative h. The AT activity was virtually stable over a period of 4 weeks in CPD-adenine red cell concentrates; fresh frozen plasma and whole blood are thus not essential as a source of AT. The application of our concept did not increase the frequency of thromboembolic complications, despite the fact that the intraoperative AT values fell below the presumed 'critical' level of 60-70% in some patients. The probable reasons are the brief duration of such levels, the simultaneous depletion of coagulation-promoting plasma constituents (e.g. fibrinogen), and the use of antithrombotic prophylaxis. Our results suggest no reasons for a routine use of fresh frozen plasma in patients with a loss and replacement of less than about 75% of their blood volume.

Antithrombin III↗
PubMed1981

Influence of a blood component program on postoperative complication rates: a retrospective study in 372 patients.

We did a retrospective study of 372 thoracic and cardiovascular surgery patients, except open heart cases, which were treated by the same senior staff during the last year before (N = 197) and the first year after (N = 175) the introduction of a blood component program. There were no other basic changes of therapeutic policies. The two populations were comparable with respect to various basic characteristics. During the period 'before' the large majority of red cell units was 'deplasmatized' blood with a plasma deficit of 100 ml and a hematocrit of 40%. During the period 'after' it was red cell concentrates with a plasma deficit of 200 ml and a hematocrit of 70%. The usage pattern of red cell units did not change. The only statistically significant (and deliberate) quantitative difference between the transfusion regimens 'before' and 'after' was a more extensive intraoperative use of a gelatin plasma substitute to balance the plasma deficit of the red cell concentrates. As judged by various criteria, the postoperative courses of the patients 'before' and 'after' were virtually indistinguishable. We conclude that the blood component program practised at our hospital has no adverse effects on the postoperative course.

Adult↗
PubMed1980

Clinical experience with 120,000 units of modified fluid gelatin.

We briefly review 20 years of clinical experience with 120.531 units of a 4% modified fluid gelatin as a plasma substitute. Its Mn is 22.500. The initial intravascular volume effect equals that of 4% albumin; the t0,5 of this effect is about 4 hours. It has no dosage-related side effects and specifically does not impair surgical hemostasis in volumes up to 10-15 litres within 24 hours. During the last 5 years, it has become an essential element of a blood component program, which has proven to be therapeutically satisfactory and logistically advantageous. More than 1000 patients have received more than 2000 ml within 24 hours as a part of massive transfusions. The incidence of serious anaphylactoid reactions has been 1 per 13,400 units, but only one fatality has occurred. At least one out of 7 "gelatin" reactions cannot have been caused by the colloid itself. These incidents were presumably due to trace contaminants. When compared to dextran, it appears that this gelatin is more prone to cause harmless cutaneous reactions, but less likely to induce severe cardiovascular incidents.

Blood Transfusion↗
PubMed1978

Red cells and gelatin as the core of a unified program for the national procurement of blood components and derivatives. Prediction, performance, and impact on supply of albumin and factor VIII.

The use of a gelatin plasma substitute as an integral part of a unified national program for the procurement of blood components and derivatives paves the way for the extensive use of red cell concentrates in the treatment of hemorrhage, the plasma from the original donations being partly diverted to the fractionation program of a national transfusion service. We estimated the potential of such a system paced by the demand for red cells and predicted that the use of 20% of fresh whole blood and 80% concentrates would not increase the demand for albumin, the yield of which would suffice to cover three-quarters of current needs in our country. The actual performance of a program using 85% of red cell concentrates in a university hospital with an exceptionally high incidence of major hemorrhage was analyzed in detail. The use of albumin per unit of transfused red cells rose by 9%. With a nationwide increase of this magnitude, 67% of the demand in our country could still be met and the estimated true need for albumin of 200 kg per million inhabitants and year would be fully covered. The yield of factor VIII is 200--300% of the demand. The determinants of the effects of such a system vary from country to country, but its fundamental potential is obviously considerable.

Blood Proteins↗
PubMed1975

[Indications for plasma substitutes].

During severe hemorrhage the O-2-transport capacity of blood is reduced due to the loss of hemoglobin. This reduction is, however, fully compensated down to 25% hematocrit by augmentation of the minute volume consequent on the decrease of blood viscosity due to hemodilution, though this holds only on condition that myocardial contractibility and total blood volume are not impaired. The compensation of lost intravasal fluid is therefore prevailing importance, but the substitute need not be blood and may consist of a suitable colloid solution. Physiogel, a modified fluid gelatin, has proved to be excellent for this primary substitution of blood losses. The plasma derivatives should be reserved for special indications, particularly for treatment of oncotic deficit, and here highly concentrated (10-20% albumin) preparations are needed. Blood transfusions are indicated when the hemoglobin content falls below the critical limit of 25% hematocrit.

Blood Coagulation↗
PubMed1974

[Reanimation].

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Heart Massage↗