Vahide Aslıhan DURAK, Özlem KÖKSAL, Mehmet KARAMURAT

Bir Üniversite Hastanesi Acil Servisi’nde Taze DonmuşPlazma (TDP) Verilen Hastaların Retrospektif Analizi

Bu çalışmanın amacı bir Üniversite Hastanesi Acil Servisi’nde TDP kullanımının retrospektif olarak incelenmesi ve bu alandaki eksikliklerin ortaya konarak transfüzyon alanında iyileşmeye gidilmenin sağlanmasıdır. Çalışmaya 01.02.2014 – 01.02.2017 tarihleri arasında bir Üniversite Hastanesi Acil Servisi’nde TDP verilen tüm hastalar alınırken, 18 yaş altı ve gebeler çalışma dışı bırakılmıştır. Toplanan verilerin kaydedildiği çalışma formunda; hastanın adı soyadı, protokol numarası, yaşı, cinsiyeti, TDP verilme endikasyonu, endikasyon uygunluğu, verilen TDP miktarı, beraberinde varsa verilen başka kan ürünü ve miktarı, transfüzyon sırasında gelişmişse komplikasyon türü, transfüzyon öncesine ait hemoglobin ve trombosit değerleri, transfüzyon öncesi ve sonrasına ait Protrombin Zamanı (PT), aktive Parsiyel Tromboplastin Zamanı (aPTT), INR değerleri, hastaların sonuçlanma şekilleri (yatış, sevk, taburculuk ve ölüm) kaydedilmiştir. Acil serviste, TDP verilen hastaların %73.9’unda uygun endikasyon saptanırken, %26.1’inde hastalara endikasyon dışı TDP verildiği gözlendi. Sonuç olarak bu çalışmadan elde edilen bulgular doğrultusunda; bir Üniversite Hastanesi AS’inde azımsanmayacak oranda uygunsuz TDP transfüzyonunun yapıldığını söyleyebiliriz. Birçok çalışmada olduğu gibi, bu çalışmada da AS’de TDP verilme endikasyonları arasında warfarin overdoz ilk sırada yer almaktadır. Uygunsuz TDP kullanımından kaçınmak için özellikle kanama bulgusu olmaksızın warfarin overdozu veya karaciğer hastalıkları nedeniyle koagülasyon parametrelerinde uzama olan hastalara TDP verilmesinden kaçınmamız gerekmektedir. Uygun TDP transfüzyonu için, mutlaka kılavuzlar kullanılmalı ve hastanelerin bu konuda kendi oluşturduğu protokolleri olmalıdır.

Retrospective Analysis of Patients Receiving Fresh Frozen Plasma (FFP) in a University Hospital Emergency Department

The purpose of this study is to investigate retrospectively the use of FFP in an university hospital emergency department and to make improvements by showing the deficiencies in this area. All the patients who had received FFP between 01.02.2014 - 01.02.2017 in university hospital emergency department were included except the pregnant patients and patients under age 18. In the study form; patient's name, protocol number, age, gender, indications for FFP, indication conformity, amount of FFP given, amount of blood product and other blood products given if accompanied, type of complications developed during transfusion, hemoglobin and platelet values before transfusion, Prothrombin Time (PT), Active Partial Thromboplastin Time (aPTT), INR values, patient outcome patterns (admission, referral, discharge and death) were recorded. In the emergency department, 73.9% of patients receiving FFP had appropriate indications however26.1% of patients had not. As a result, in the direction of the findings obtained from this study; inappropriate FFP transfusion was made in high rates and like other studies warfarin overdose is among the first indications for FFP administration in emergency department. In order to avoid inappropriate FFP transfusion, we need to avoid giving FFP to patients with prolonged coagulation parameters, especially due to warfarin overdose or liver diseases without evidence of bleeding. For appropriate FFP transfusion, guidelines must be used and hospitals should have their own protocols in this regard.

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