每日一题_2022.09.05

A 43-year-old man undergoes an exploratory laparotomy for appendiceal carcinoma as a possible curative intervention. He loses a significant amount of blood that requires transfusion of six units of packed red blood cells (PRBCs), two units of fresh frozen plasma (FFP), and a six-pack of platelets. The post-transfusion complete blood count results are: white blood cell count 12,300/μL, hemoglobin 12.2 g/dL, hematocrit 36.5, platelets 122/mm3. INR is 1.2. Partial thromboplastin time is within normal limits. The patient continues to ooze in the post-anesthesia care unit. Thromboelastography (TEG) is ordered because coagulopathy is suspected. TEG results are: reaction time, 4.5 min; kinetics, 2.3 min; alpha, 55 degrees; maximum amplitude, 65 mm; amplitude at 30 minutes, 3.5%; and coagulation index, -2.1. He does not take any anticoagulants at home, and he was not given any during surgery.

Based on this information, which of the following is the most appropriate next step in treatment?

A. PRBCs

B. FFP

C. Tranexamic acid

D. Platelets

E. 0.9% normal saline

答案解析：

这可能代表手术出血，这可能受益于氨甲环酸给药，或者如果足够严重，可以进行手术探查。 血栓弹力图 (TEG) 经常用于查明导致异常凝血的缺陷。 好处已经确定，特别是对于心脏手术。 血液学和 TEG 值均在正常范围内； 没有理由给予额外的血液制品。 给予生理盐水会适得其反，因为它会稀释现有的凝血因子。

正确答案：C