Kordzadeh_2017.pdf (1.65 MB)
Blood and blood component transfusion on 30-day mortality and morbidity of infra-renal ruptured abdominal aortic aneurysm
thesis
posted on 2023-08-30, 15:02 authored by Ali KordzadehThis thesis for the first time in the literature, through a single cohort (n=82),
systematic review and meta-aggregation of the data, has identified that the
majority (>85%) of ruptured abdominal aortic aneurysm (rAAA) do not present
with coagulopathy. In addition, the thesis for the first time, through a retro and
prospective cohort study, has demonstrated that the hemostatic resuscitation
protocols derived from military and civilian trauma for the correction of
coagulopathy with a blood product ratio of one unit of packed red blood cell to
one unit of fresh frozen plasma to one pool of platelet (1:1:1), contributes to
increased postoperative (30-day) morbidity and mortality, especially thrombotic
complications. This was attributed to different baseline demographics,
pathophysiology and coagulation status. Through a comparative study, the
thesis then confirms that such transfusion practice not only contributes to
adverse outcomes, but also has no impact on final coagulation status of rAAAs.
In addition, through a retro and prospective cohort study, a novel hematological
marker (neutrophil to lymphocyte ratio) (NLR) was identified as an independent
predictor of morbidity in rAAAs. This thesis was set on the background of
significant research into all factors that could contribute to pathogenesis,
inhibition and progression of rAAAs.
This thesis concludes that the use of additional blood products (fresh frozen
plasma and platelet) in hemostatic resuscitation of ruptured abdominal aortic
aneurysms alongside packed red blood cell is not evidence based and a single
protocol derived from one cohort (military and civilian trauma) of patients does
not apply to another. The use of additional products in ruptured abdominal aortic
aneurysms should be tailored to the individual hematological and clinical
requirements and not as a part of a set transfusion ratio (1:1:1). This thesis has
resulted in a change of practice and has created a platform for further search of
the optimal transfusion protocol in this cohort of patients.
History
Institution
Anglia Ruskin UniversityFile version
- Accepted version
Language
- eng
Thesis name
- Other
Thesis type
- Doctoral
Legacy posted date
2018-01-03Legacy creation date
2018-01-03Legacy Faculty/School/Department
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