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13 results on '"Kempf, Reiner"'

6. Predictors of Intraoperative Blood Transfusion in Free Tissue Transfer.

Author

Kolbenschlag, Jonas, Schneider, Johanna, Harati, Kamran, Goertz, Ole, Hernekamp, Jochen Frederik, Kempf, Reiner, Lehnhardt, Marcus, and Hirsch, Tobias

Subjects
TISSUES, BLOOD loss estimation, RED blood cell transfusion, BLOOD flow, BLOOD circulation, SURGERY
Abstract

Background Free tissue transfer has become a safe and reliable procedure and is routinely used in a variety of settings. However, it is associated with lengthy operating times and a high potential for blood loss and consecutive red blood cell transfusions (RBCTs). Methods To assess the risk for RBCTs, we retrospectively identified 398 patients undergoing free tissue transfer between 2005 and 2014. Based on a multivariate model of risk factors and their respective odds ratio, a risk score was developed to predict the likelihood of the need for intraoperative RBCT. Results The median age at the time of operation was 51.3 ± 15 years, and 278 (70%) patients were male. The average body mass index was 25.9 ± 4 and the median ASA score was 2 (range: 1-4).Mean duration of surgery was 319.8 ± 108 minutes andmean duration of hospital stay was 45.8 ± 40 days. A total of 231 patients (58%) required perioperative RBCTs, all of which were allogenic. RBCTs were performed 0 to 48 hours preoperatively in 36 patients (11.3%), intraoperatively in 166 patients (41.7%), and 0 to 48 hours postoperatively in 125 patients (31.4%). The mean amount of overall RBCTs given was 2.5 ± 3.7 units and 1.1 ± 1.9 units for intraoperative transfusions. The following risk factors were statistically significant in the multivariate regression analysis and included in the risk score: age >60 years; a preoperative hemoglobin concentration of <11 g/dL; a preoperative platelet count of >400/nL; history of renal (RI) and cardial insufficiency (CI); defect localization on the proximal extremities, head and neck, or trunk; and the use of myocutaneous flaps. This score assessed the risk for RBCTs with a sensitivity of 77%, a specificity of 81%, and an AUC of the ROC curve of 0.86. Conclusion We were able to develop a risk score that allows for the assessment of RBCT likelihood. While most of the identified risk factors cannot be prevented or corrected, it still allows for improved patient counseling and can potentially reduce the number of ordered but not transfused RBCTs. [ABSTRACT FROM AUTHOR]

Published
2016
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8. Platelet receptor and clotting factor polymorphisms as genetic risk factors for thromboembolic complications in heparin-induced thrombocytopenia.

Author

Carlsson, Lena E, Lubenow, Norbert, Blumentritt, Carmen, Kempf, Reiner, Papenberg, Stephanie, Schröder, Winnie, Eichler, Petra, Herrmann, Falko H, Santoso, Sentot, Greinacher, Andreas, Carlsson, Lena E, Lubenow, Norbert, Blumentritt, Carmen, Kempf, Reiner, Papenberg, Stephanie, Schröder, Winnie, Eichler, Petra, Herrmann, Falko H, Santoso, Sentot, and Greinacher, Andreas

Abstract

Heparin-induced thrombocytopenia (HIT) is an immune mediated adverse reaction to heparin treatment often associated with limb- and/or life-threatening thromboembolic complications (TECs). Presently, no prognostic marker has been identified that allows differentiation between mildly (isolated thrombocytopenia) and severely (TECs) affected patients. This study assesses the impact of platelet glycoprotein- and clotting factor polymorphisms in HIT-patients with isolated thrombocytopenia compared to HIT-patients with TECs. Sixty-three HIT-patients with isolated thrombocytopenia and 79 HIT-patients with HIT-related TECs were genotyped for GPIIb-IIIa polymorphisms (HPA-1, HPA-3), GPIa-IIa polymorphisms (HPA-5, GPIaC807T), GPIb-IX-V polymorphisms (HPA-2, Kozak-5, VNTR), and clotting factor polymorphisms (FV-Leiden R506Q, prothrombin PT-G20210A and MTHFR C677T). Women more often presented with TECs than men (P = 0.04). No differences in genotype frequencies could be seen on comparing HIT-patients with and without TECs. Analysing men and women separately, the C allele of the Kozak polymorphism was overrepresented in men who developed TECs (P = 0.034). The enhanced risk of women to develop HIT-associated TECs remains unexplained but it is potentially important in view of recent data on sex-hormone related changes of haemostasis. There was no correlation between platelet glycoprotein- and clotting factor polymorphisms and the risk to develop HIT-associated TECs. An association between the development of TECs and the Kozak-5C allele could be seen among male patients. However, this would need to be assessed in further larger studies. Most likely, the high levels of thrombin generation during acute HIT are so procoagulant that less pronounced risk factors such as polymorphisms are overshadowed.

Published
2003
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11. Platelet receptor and clotting factor polymorphisms as genetic risk factors for thromboembolic complications in heparin-induced thrombocytopenia

Author

Carlsson, Lena E, primary, Lubenow, Norbert, additional, Blumentritt, Carmen, additional, Kempf, Reiner, additional, Papenberg, Stephanie, additional, Schr??der, Winnie, additional, Eichler, Petra, additional, Herrmann, Falko H, additional, Santoso, Sentot, additional, and Greinacher, Andreas, additional

Published
2003
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12. Heparin-Induced Thrombocytopenia

Author

Lubenow, Norbert, primary, Kempf, Reiner, additional, Eichner, Angelika, additional, Eichler, Petra, additional, Carlsson, Lena E., additional, and Greinacher, Andreas, additional

Published
2002
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13. Platelet receptor and clotting factor polymorphisms as genetic risk factors for thromboembolic complications in heparininduced thrombocytopenia

Author

Carlsson, Lena E., Lubenow, Norbert, Blumentritt, Carmen, Kempf, Reiner, Papenberg, Stephanie, Schröder, Winnie, Eichler, Petra, Herrmann, Falko H., Santoso, Sentot, and Greinacher, Andreas

Abstract

Heparininduced thrombocytopenia HIT is an immune mediated adverse reaction to heparin treatment often associated with limb andor lifethreatening thromboembolic complications TECs. Presently, no prognostic marker has been identified that allows differentiation between mildly isolated thrombocytopenia and severely TECs affected patients. This study assesses the impact of platelet glycoprotein and clotting factor polymorphisms in HITpatients with isolated thrombocytopenia compared to HITpatients with TECs. Sixtythree HITpatients with isolated thrombocytopenia and 79 HITpatients with HITrelated TECs were genotyped for GPIIbIIIa polymorphisms HPA1, HPA3, GPIaIIa polymorphisms HPA5, GPIaC807T, GPIbIXV polymorphisms HPA2, Kozak5, VNTR, and clotting factor polymorphisms FVLeiden R506Q, prothrombin PTG20210A and MTHFR C677T. Women more often presented with TECs than men P0.04. No differences in genotype frequencies could be seen on comparing HITpatients with and without TECs. Analysing men and women separately, the C allele of the Kozak polymorphism was overrepresented in men who developed TECs P0.034. The enhanced risk of women to develop HITassociated TECs remains unexplained but it is potentially important in view of recent data on sexhormone related changes of haemostasis. There was no correlation between platelet glycoprotein and clotting factor polymorphisms and the risk to develop HITassociated TECs. An association between the development of TECs and the Kozak5C allele could be seen among male patients. However, this would need to be assessed in further larger studies. Most likely, the high levels of thrombin generation during acute HIT are so procoagulant that less pronounced risk factors such as polymorphisms are overshadowed.

Published
2003
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