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Biomedical subjects

P Lundsgaard-Hansen

Publications and source records attributed to P Lundsgaard-Hansen.

At least 37 records · Page 2Linked 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↗
PubMed1983

Plasma fibronectin and associated variables in surgical intensive care patients.

An acute depletion of plasma fibronectin or FN has been observed in critically ill, surgical, or trauma patients, but there is little information on the relationships between FN levels and the final outcome in such cases, and on the simultaneous behaviour of other serum proteins. The daily values of FN, antithrombin III, IgG, C3, prealbumin, and transferrin were monitored in 98 intensive care patients after major elective surgery or trauma. According to their clinical course, they were divided retrospectively into three groups. Group A (33 patients) had sepsis. Group B (31 patients) had nonseptic complications, and group C (34 patients) had no complications in the ICU. The individual, nadir levels of FN, AT III, prealbumin, and transferrin were lower (p less than 0.01) in the septic group A than in B and C. Within the septic group, the nadir levels of AT III, but not those of FN, were lower (p less than 0.01) in the 14 nonsurvivors than in the 19 survivors. The FN and AT III levels had returned at least temporarily to the normal range in the six ultimate fatalities from sepsis who survived for more than two weeks. In the septic group, transferrin showed the highest percentages of actually subnormal levels and differed from FN in this respect with p less than 0.05. Furthermore, all six proteins showed a significant overall pattern (p less than 0.01) of parallel variations. The results confirm other reports on the behavior of fibronectin in septic patients as a group, but it was not informative as to the individual outcome, and its reduction might be viewed as part of a general plasma protein depletion associated with acute septic disease. This pattern is probably attributable to a combination of intravascular consumption and an overall excess of protein catabolism over synthesis.

Adolescent↗
PubMed1983

Use of plasma volume substitutes and plasma in developing countries.

Plasma and plasma substitutes are used in the treatment of various conditions such as haemorrhage and shock. This article examines the role of crystalloids, artificial colloids, human plasma, human albumin, and plasma protein fraction, in the treatment of such patients, with particular reference to peripheral health facilities in developing countries.It is concluded that 0.9% saline, together with 5-6% dextrose, is of particular importance in this situation since it is easy to produce locally, is stable at high temperatures, and has a low cost/benefit ratio. The second priority is to ensure the availability of a limited quantity of one or more colloid plasma substitutes. In the field of plasma, fresh frozen or fresh liquid plasma is most useful for the treatment of various haemostatic derangements and follow-up treatment of severe burns, since it contains the widest spectrum of therapeutically useful components and can be produced locally with an acceptable degree of difficulty.The treatment of severe diarrhoea with special alkaline electrolyte solutions and oral rehydration solutions is also outlined.

Burns↗
PubMed1983

[The concept of blood components in surgical hemotherapy ].

During the past 7 years, 85% of all red cell units have been transfused as concentrates (RCC) with a haematocrit of 70% at our University Hospital. The basic concept is to exploit the differing critical levels of various parameters in the circulation of the patient. In per cent of normal, we have: blood volume 100%, haematocrit 80%, total serum protein 60%, plasmatic coagulation factors 35%, and platelets 25%. This permits the stepwise use of a plasma substitute, RCC, 5% albumin, and fresh frozen plasma or whole blood. A retrospective, but carefully controlled study of 372 patients showed that this system has no negative effects on the postoperative course. Its logistic advantage is that the plasma from the blood donations used to treat about 80% of surgical patients can be diverted to fractionation into specific derivatives, whereas it does not increase the needs for albumin.

Blood Pressure↗
PubMed1982

[Experience with a blood component program in surgical hemotherapy].

Within the component concept applied during the past 6 years at the University Hospital in Berne (Switzerland), 85% of all red cell units are transfused as concentrates with a hematocrit of 70%, and the remaining 15% as fresh whole blood. The rationale in surgical patients is to exploit the different "critical levels" of the blood volume, hematocrit, total serum protein, plasmatic coagulation factors, and platelets. A colloid plasma substitute compensating for the plasma deficit of the red cell concentrates is an integral part of the system. A carefully checked, retrospective study in 372 patients revealed no disadvantages for the postoperative course. During the first 4 1/2 years after its introduction it did not increase the demand for human plasma protein solutions. With the red cells as a pacemaker for the number of blood donations, this system can simultaneously cover a reasonable national demand for albumin and factor VIII.

Blood Transfusion↗
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↗
PubMed1981

Colloids versus crystalloids as volume substitutes: clinical relevance of the serum oncotic pressure.

With some amplifications, Starling's concept of the serum colloid osmotic or oncotic pressure as the determinant of fluid partition between the intravascular and the interstitial compartment has been confirmed by modern physiological research. The relationship between serum oncotic pressure and interstitial edema is non-linear, i.e. edema becomes progressively greater per mm decrease of the oncotic pressure. The intravascular volume effect of crystalloids is inseparable from interstitial edema, because it depends on an expansion of the interstitium which increases the hydrostatic pressure in that compartment sufficiently to compensate for a lowered capillary oncotic pressure. With large crystalloid fluid loads, about 90% of the total edema accumulates in skeletal muscle, subcutaneous fat, and the skin. The skin is particularly susceptible to the development of edema associated with a hypoproteinemic fluid overload, presumably because its extracellular space is three times larger than the average whole-body value. The intestine also shows a marked reaction to a hypoproteinemic fluid overload. There is evidence for a pathogenetic significance of hypoproteinemic edema in the myocardium, the intestine, and the skin. To rid a patient of this type of edema, concentrated albumin is indispensable, and its effects are demonstrable in the above-mentioned tissues, whereas a diuretic alone is ineffective. The therapeutic implications of these mechanisms and findings are discussed. In the lung, fluid exchange and distribution between the intravascular and the interstitial compartment is influenced by additional factors, and opinions on the use of colloids versus crystalloids continue to differ, particularly with respect to those circumstances where capillary permeability is presumably or demonstrably abnormal. However, the weight of the evidence still favours the concept that in patients with a much greater than respiratory distress syndromes much greater than, the serum oncotic pressure should at any rate not be permitted to drop below a certain critical level. A condensed review of these complex and as yet incompletely clarified problems is presented.

Blood Physiological Phenomena↗
PubMed1980

A blood component program for the treatment of surgical haemorrhage and its potential for national supplies of albumin and factor VIII.

For medical as well as logistic reasons, the importance of blood component therapy is rapidly increasing. The use of red cell concentrates in conjunction with an appropriate plasma substitute for the treatment of surgical haemorrhage "liberates" substantial quantities of plasma for the fractionation to derivatives, among which albumin and factor VIII are particularly needed. The experience obtained in Berne with the application of this principle is presented and its implications for the coverage of national demands for albumin and factor VIII are discussed.

Blood Transfusion↗
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↗
PubMed1980

Donor safety in plasmapheresis.

Whereas European authorities stipulate that a plasmapheresis donor should not give more than about 250 ml of plasma per week, American regulations continue to sanction a weekly "harvesting" volume of 1000 ml. The latter volume equals one third of a donor's plasma volume, and the loss of plasma proteins are identical with those of a patient suffering from a severe nephrotic syndrome. Accordingly, such donors develop hypoproteinemia, hypoalbuminemia, hypogammaglobulinemia, and abnormal electrophoretic patterns. Recent data give cause for concern with respect to evidence for an increased aggregating tendency of platelets. Pending the clarification of these problems, the necessary quantities of plasma should be procured by increasing the number of donors sufficiently to respect the European volume limitations.

Agammaglobulinemia↗
PubMed1980

Clinical indications for human serum albumin.

Three indications have been considered for the clinical use of human serum albumin: nutrition, binding and transport, and the volume effect due to the oncotic properties of the protein. The use of albumin as an intravenous nutrient is clearly inappropriate. The literature on its binding and transport properties is as yet clinically inconclusive, and it seems premature to enforce product specifications based on these characteristics. The effects on blood volume and hypoproteinemia are firmly established in patients with an intact capillary system. The therapeutic implications of a capillary "permeability lesion" are a subject of current debate. Such lesions occur following extensive injuries and in patients with septic pulmonary failure. Although the data are contradictory, it is largely agreed that the serum albumin level should be kept above 30 g/litre or the total serum protein above 50 g/litre.

Colloids↗