Recommendations for the Use of Therapeutic Plasma
Recommendations for the Use of Therapeutic Plasma
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DOI：
10.2174/157016109787455671
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发表时间：
2009-04-01
影响因子：
4.5
通讯作者：
Hellstern, Peter
中科院分区：
文献类型：
--
作者：
Heim, Marcell Ulrich;Meyer, Britta;Hellstern, Peter
大多数欧洲国家批准了四种血浆制剂：新鲜冷冻血浆、冻干血浆、溶剂/洗涤剂（SD）处理血浆和亚甲蓝/光处理血浆。血浆临床疗效的证据主要基于对照或非对照观察性研究、病例报告或专家意见。由于以往指南和建议中证据等级的定义复杂，难以应用于临床常规，我们建立了一个包含2个推荐强度（1和2）和3个证据等级（a、B、C）的简单系统。血浆适用于伴有明显或即将出血的复杂凝血功能障碍，特别是大量输血、弥散性血管内凝血和肝脏疾病的微血管出血。除了凝血测定结果不能及时获得的紧急情况外，必须在给予血浆之前验证临床相关的凝血病。需要每公斤体重至少10毫升血浆的快速输注，以显著提高各自的凝血因子或抑制剂水平。治疗性血浆置换是治疗急性血栓性血小板减少性紫癜（TTP）或成人溶血性尿毒症综合征（HUS）的首选方法。罕见适应症为先天性因子V或FXI缺乏，重度溶血或高胆红素血症新生儿血浆置换，新生儿体外膜氧合充氧器。对于口服抗凝的快速逆转，凝血酶原复合物浓缩液应优先于血浆，因为血浆在这种情况下效率较低。血浆给药引起的副作用很少见，但必须加以考虑。
Four approved plasma preparations are available in most European countries: fresh frozen plasma, lyophilized plasma, solvent/detergent(SD)-treated plasma and methylene blue/light-treated plasma. Evidence of the clinical efficacy of plasma is mainly based on controlled or uncontrolled observational studies, case reports or expert opinion. As definitions of evidence grades used in previous guidelines and recommendations are sophisticated and difficult to apply to clinical routine, we established a simple system involving 2 recommendation strengths (1 and 2) and 3 evidence grades (A, B, C). Plasma is indicated for complex coagulopathy associated with manifest or imminent bleeding, particularly microvascular bleeding, in massive transfusion, disseminated intravascular coagulation and liver disease. With the exception of emergency situations when clotting assay results are not available on time, a clinically relevant coagulopathy must be verified before plasma is administered. The rapid infusion of at least 10 ml of plasma per kg of body weight is required to increase the respective clotting factor or inhibitor levels significantly. Therapeutic plasma exchange with 40 ml of plasma per kg of body weight is the treatment of first choice in acute thrombotic-thrombocytopenic purpura (TTP) or adult hemolytic uremic syndrome (HUS). Rare indications are congenital factor V or FXI deficiency, plasma exchange in neonates with severe hemolysis or hyperbilirubinemia, and filling of the oxygenator in extracorporeal membrane oxygenation in neonates. Prothrombin complex concentrates should be preferred to plasma for the rapid reversal of oral anticoagulation, since plasma is less efficient in this setting. Side effects resulting from the administration of plasma are rare but have to be considered.