Rinsho byori. The Japanese journal of clinical pathology
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Review
[Role of the clinical laboratory for patients with massive transfusion undergoing elective surgery].
The microvascular bleeding resulting from the dilutional coagulopathy can occur when patients with massive blood loss are treated by infusing a lot of crystalloids, colloids, and red blood cell concentrates. For the management of dilutional coagulopathy and the appropriate replacement therapy of with coagulation factors and platelets, we usually monitor the patient's course of with platelet count, conventional coagulation tests such as the prothrombin time, the activated partial prothrombin time, and the fibrinogen concentration. The central clinical laboratory has a responsibility for an accurate and quick report of these test results of patients with massive transfusion. Furthermore, use of point care testing is of clinical value to fulfill a clinical demand in case with dilutional coagulopathy.
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Massive hemorrhage during surgery often results from diluted coagulopathy due to loss of coagulation factors (e.g., fibrinogen), especially in cases of thoracic aortic aneurysm and liver transplantation. The most important issue in preventing massive hemorrhage during surgery is transfusion therapy for hemostasis. When massive hemorrhage occurred in cases of the above surgery, we measured the fibrinogen level in plasma, and administered cryoprecipitate or fibrinogen concentrate to the patient when the fibrinogen level was below 150 mg/dL. ⋯ The number of cases of early death due to massive hemorrhage during surgery decreased by 75% when cryoprecipitate or fibrinogen concentrate was used. Thus, in patients showing hypofibrinogenemia (i.e., <150 mg/dL) during surgery, administration of cryoprecipitate or fibrinogen concentrate should be effective in establishing hemostatsis, and therefore in reducing blood loss and number of transfusion units. This treatment should help to improve the prognosis of patients in surgery, and also to decrease the use of blood products.
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Airflow obstruction is the most important pathophysiologic factor in chronic obstructive pulmonary disease (COPD). Although the prevalence of airflow obstruction has been increasing worldwide, airflow obstruction is often under-recognized in clinical practice because of insufficient use of spirometry. The aim of the present study was to identify unrecognized airflow obstruction in cases with lifestyle-related diseases using a data mining system that we have developed for use with electronic medical records. ⋯ Latent COPD patients with airflow obstruction are highly prevalent, not only in those over 70 years of age with lifestyle-related diseases, but also in middle-aged patients. Spirometry should be widely used for patients with lifestyle-related diseases and a history of smoking, to effectively detect undiagnosed COPD.