Infusionstherapie (Basel, Switzerland)
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The common features of all different kinds of circulatory shock are a disturbance of the microcirculation and an imbalance between cellular oxygen demand and supply. The pathophysiology is discussed by the example of hypovolemic-hemorrhagic shock, including macrocirculation, humoral regulatory mechanisms, the role of vascular endothelium, and cellular dysfunction. The first aim of therapeutic efforts is the rapid restitution of a normal circulatory volume as a basic requirement for the normalisation of the microcirculation. Actual concepts of volume substitution and transfusion therapy are presented.
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The risks and adverse reactions of fresh frozen plasma (FFP) and coagulation components have changed considerably in the last few years because of the spread of HIV on the one hand, and the advances in preparation and sterilisation of the coagulation components on the other hand. Therefore, the indication for FFP and the various coagulation components deserves permanent consideration. FFP is still the therapeutical means of choice for the treatment of acquired (complex) plasmatic coagulation disorders, even though the (still) small risk of virus transmission in Middle Europe has to be taken into account. ⋯ Finally, the necessity of accurate diagnosing is emphasized. Close cooperation between the physicians in the clinics and in the department of transfusion medicine/hemostaseology reduces unnecessary and inadequate application of coagulation components. This also means an improvement in the patient's therapy.