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Critical care, also called intensive care, is the close monitoring and treatment given to patients with acute, life-threatening illness or injury such as shock, burns, accidents, complex surgery, sepsis and severe breathing problems.  It usually takes place in an Intensive Care Unit (ICU) or trauma center.


Several plasma-derived therapies are commonly used in critical care situations:

 

Human Albumin

Albumin is the most abundant protein in human blood plasma, making up about half of total blood serum protein.  

Albumin is a multifunctional protein that has a diversity of biological functions and effects. It is principally used to maintain blood volume in critically ill patients with low volume (hypovolemia).

Human albumin has been used as a therapeutic agent in intensive care units for more than 50 years.

Antithrombin

Antithrombin is a plasma protein that inactivates Thrombin, a plasma enzyme that is important in the clotting process. Antithrombin therefore acts as a powerful anticoagulant and is used to treat acquired antithrombin deficiency from disseminated intravascular coagulation (DIC) as the result of sepsis, multiple trauma, severe burns, pregnancy complications, extensive surgery, etc.

Antithrombin is also used in patients with congenital antithrombin deficiency for the prophylaxis of deep vein thrombosis and thromboembolism in clinical risk situations (especially during surgery or during the peri-partum period) and for the prevention of progression of deep vein thrombosis and thromboembolism in association with heparin, when indicated.

 

Prothrombin complex coagulation factors (PCC)

PCC is a complex of human plasma coagulation factors for treatment of bleeding and perioperative prophylaxis of bleeding in acquired prothrombin deficiency, when rapid correction of the deficiency is required. 

PCC is also used for treatment of bleeding and perioperative prophylaxis in congenital deficiency of any of the vitamin K dependent coagulation factors when purified specific coagulation factor product is not available. 

Plasma S/D

Plasma S/D is fresh frozen plasma (FFP) with a high degree of security because it has undergone treatment with solvent/detergent  in order to destroy or inactivate many viruses.  It is used in critical care for the same indications of FFP:

 

  • Combined deficiency of coagulation factors such as consumption coagulopathies (Disseminated intravascular coagulation - DIC) or coagulopathy due to severe liver failure or massive transfusion.
  • Replacement therapy in deficiency of coagulation factors, in emergency situations when the concentrate is not available to a specific coagulation factor, such as the factor V or factor XI, or when it is not possible to determine specific factor deficiency.
  • Resolution of fibrinolytic activity and rapid resolution of the effect of oral anticoagulants when the action of vitamin K is insufficient for hepatic impairment or in emergency situations.

Reference:
1.    Rita Garcia-Martinez. Albumin: Pathophysiologic Basis of Its Role in the Treatment of Cirrhosis and Its Complications. HEPATOLOGY, Month 2013
2.    Afshari A. Antithrombin III for critically ill patients (Review). The Cochrane Library 2009, Issue 2
3.    Sibylle A. Management of severe perioperative bleeding. Eur J Anaesthesiol 2013; 30:270–382
4.    Debora Lepri. Utilizzo clinico di plasma virus-inattivato. Recenti Progressi in Medicina, 104 2 (1), Marzo 2013