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Background: Chemical pleurodesis is frequently used to treat chronic pneumothorax (PTX) with pulmonary air leak in patients that are high-risk for surgery. More recently, commercial fibrin sealants, typically virus-inactivated human fibrinogen and thrombin, have been successfully used in these patients. Several fibrin sealant preparations have been available in Europe for more than 20 years and in the United States since May 1998. Topical fibrin glue, a less expensive alternative to commercially available fibrin sealants, is prepared by mixing cryoprecipitate, bovine thrombin and calcium. The use of cryoprecipitate glue for pleurodesis has rarely been reported. We describe two cases in which persistent pneumothoraces were successfully treated by intrapleural instillation of cryoprecipitate glue via chest tube. Case report - 1: A 78-year-old male with severe emphysema developed a posttraumatic right apical PTX. Three weeks later, his dyspnea worsened with oxygen saturation of 94% on 3 liters of oxygen via nasal cannula. The PTX persisted despite one week of chest tube drainage at 20 cm of water suction and an attempt at pleurodesis with intrapleural Doxycycline. Intrapleural instillation of cryoprecipitate glue via a chest tube was performed using 4 units of cryoprecipitate closely followed by 1000 units of bovine thrombin and 0.1 mi of 10% CaCl. Saline was injected into the chest tube after both cryoprecipitate and thrombin to prevent fibrin occlusion of the chest tube. The patient's bed was kept in the Trendelenberg position for 5 minutes. The air leak resolved immediately after the cryoprecipitate glue instillation and a subsequent chest X-ray revealed resolution of the PTX. The patient's exercise capacity improved and there was no evidence of recurrence of PTX at a two-week follow up. Case report - 2: A 73-year-old man with severe ankylosing spondylitis, ischemic heart disease and restrictive lung disease underwent right lower lobe decortication for a chronic pleural effusion. The procedure was complicated by formation of a brenchopleural fistula with right basilar PTX. A chest tube in place for three months did not resolve the PTX and he developed respiratory distress with oxygen saturation of 92% on 2 liters of oxygen via nasal cannula. He then underwent cryoprecipitate glue-pieurodesis similar to case-1, using 6 units of cryoprecipitate. Chest X-rays obtained the following day and at two weeks showed absence of recurrence. Conclusion: Intrapleural instillation of cryoprecipitate glue may be an effective and less expensive alternative to commercial fibrin sealant in the treatment of high-risk patients with persistent PTX. [ABSTRACT FROM AUTHOR]

Background: The corrected count increment (CCI) can standardize assessment of platelet transfusions by correcting for patient's body surface area (BSA) and platelet dose (PD). By using a fixed CCI and a desired post-transfusion platelet count, CCI formula can be used to calculate PD based on patient's BSA. Our transfusion service has used the following formula since May 1990, to determine the PD for non-bleeding patients: PD = (Desired post minus pro-transfusion platelet count/mL) × (BSA in m²)/(7000/mL × 1.7), where PD is expressed in number of platelet concentrates, 7000 is the expected platelet count increment per unit transfused, and 1.7 is BSA in m² in a 70-kilogram adult. This study evaluated the clinical value of this approach. Methods: A retrospective review was performed of all 2202 platelet transfusions at our hospital between 1/1/98 and 12/31/00. In 89 cases a calculated PD was determined prior to transfusion and these were evaluated for platelet increments at 1, 1-18, or 18-24 hours post-transfusion. The transfusions that used the calculated PD were compared with those that did not. Results: 83 transfusions in 69 patients were reviewed (see table). The background clinical conditions were: miscellaneous uncomplicated cases 49%, sepsis 25%, hematological malignancy 16%, coagulopathy secondary to alcoholic hepatitis 6%, and solid tumor 4%. No difference in mean platelet count increments was noted between the two groups (p=0.46). Conclusion: While calculated platelet dose can reduce the number of donor exposures and also identify cases that need more than the conventional dose based on BSA, its overall impact on platelet transfusion response appears less significant. [ABSTRACT FROM AUTHOR]