Mahmut Mustafa ULAŞ, Necmettin ÇOLAK, Kumral ERGÜN, Gökhan LAFÇI, HACI ALPER UZUN, ADNAN YALÇINKAYA, Ersin KADİROĞULLARI, Emre YAŞAR, Ömer Faruk ÇİÇEK, Kerim ÇAĞLI

Effects of fresh frozen plasma on hematologic parameters in open heart surgery

Açık kalp cerrahisi yapılan hastalarda taze donmuş plazma (TDP) transfüzyonunun doza bağımlı olarak hematolojik parametrelere olan etkilerinin ve klinik bulgularının prospektif olarak belirlenmesi amaçlanmıştır. Hastalar intraoperatif veya postoperatif TDP ihtiyaçlarına göre iki gruba ayrıldı.Grup A (n=68),0-2U arası, Grup B (n=32), 3 ve üzeri TDP kullanan hastalardan oluşturuldu. Preoperatif ve postoperative hematolojik parametreler analiz edildi ve karşılaştırıldı. Postoperatif dönemde ateş ve enfeksiyon mevcudiyeti, üre, alanine aminotranferaz (ALT) ve C-reaktif protein (CRP) düzeyleri incelendi ve gruplar arasındaki end-organ hasarı ile inflammatuar yanıtları karşılaştırıldı. Operasyon sonrasında, Hemoglobin (Hb), Hematokrit (Hct) düzeyleri ve platelet sayıları belirgin olarak azalmıştı. Lökosit sayısı ve nötrofil ile monosit oranları postoperative dönemde artarken, lenfosit, eozinofil ve bazofillerde belirgin derecede düşüklük mevcuttu. Gruplar karşılaştırıldığında; total lökosit sayıları ve eozinofil hariç diğer lökosit subtiplerinin sayısı Grup B’de Grup A’dan belirgin olarak daha azdı. Toplam hastaların %30’da 38ºC’nin üzerine çıkabilen ateş tespit edildi, gruplar arasındaki oran benzerdi. Her ne kadar CRP, üre ve ALT seviyelerinde operasyon sonrasında her iki grupta da belirgin artış oluşsa da gruplar arasında parametlerin dikkatle incelenmesi ile anlamlı bir farklılık tespit edilemedi. Bu çalışmada postoperative dönemde 2U’nin üzerinde verilen TDP transfüzyonunun postoperative lökositozu belirgin derecede azalttığı gözlenmiştir. Ancak lökositozdaki bu azalma end organ hasarı ile ilişkili inflamasyonun önlenmesinde beklenen klinik düzelmeyi sağlamamıştır.

Açık kalp cerrahisinde taze donmuş plazmanın hematolojik parametreler üzerine etkisi

To prospectively determine whether fresh frozen plasma transfusion affects hematologic parameters in a dose dependent manner in patients undergoing open heart surgery and its clinical significance. Patients were divided into two groups according to the total intra-and/or postoperative fresh frozen plasma (FFP) requirement. Patients who need 0 to 2 units were included in Group A (n=68) and 3 units in Group B (n=32). Preoperative and postoperative hematologic parameters were analyzed and compared between groups. Presence of postoperative fever, infection and level of urea, alanine aminotransferase (ALT) and Creactive protein (CRP) were also evaluated and compared between groups for inflammatory response and end-organ injury. After operation, Hemoglobin (Hb), Hematocrit (Hct) level and mean platelet count were decreased significantly. Whereas white blood cells (WBC) count and numbers of neutrophil and monocyte in formulation were increased postoperatively, other types of WBC (lymphocyte, eosinophil and basophil) were decreased significantly. Comparison of the groups revealed that total count of WBCs and count of subtypes except for eosinophil were significantly smaller in Group B than in Group A. Fever>38ºC was observed in 30% of all patients with a similar rate between groups. Although level of CRP, urea and ALT in both groups increased significantly after operation, no significant difference was observed between groups with regard to these parameters. This study demonstrated that postoperative transfusion of >2 units of FFP can reduce postoperative leukocytosis significantly but it could not establish clinical improvement which would be expected as a result of the prevention of inflammation related end-organ injury

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