Thursday, April 30, 2020
Sport Is Greatest School Of Vanity Essay Example For Students
Sport Is Greatest School Of Vanity Essay Sport Is The Greatest School Of VanityIt is two oââ¬â¢clock on Saturday the 22 February 2000. It is the day of the annual Hilton VS Michael House rugby game. In the stands, five hundred schoolboys eagerly await the arrival of the fifteen so-called ââ¬Å"Godsâ⬠dressed in the black and white to come racing onto the field. As the ââ¬Å"Titansâ⬠take the field all five Hundred of them jump up and praise them in one euphoric roar. The out come of the game is eight to five in Hiltons favor. They all run on and form a circle around the fifteen victorious ââ¬Å"Gladiatorsâ⬠and as they sing Oââ¬â¢ boys the spirit and not to mention the egoââ¬â¢s are raised to an all time high. We will write a custom essay on Sport Is Greatest School Of Vanity specifically for you for only $16.38 $13.9/page Order now It is three oââ¬â¢clock on Saturday the 12 November. It is the Natal Witness inter-schools chess championship and Hilton College has made it to the finals. The best players from either side are competing for one of the most prestigious chess titles in South Africa. In the stands, nobody, as usual. The pressure is getting to both of the boys, but in the end Hilton pulls through with a tight win. The boys get into the bus and go back to school. Monday morning comes and the whole school is ââ¬Å"bowingâ⬠down to the almighty fifteen who by this stage are over flowing with arrogance and contemptuous pride. The praise that they receive is almost overwhelming. Monday morning comes and no one even says good morning to the members of the chess team. The praise that they receive for their good effort is non-existent. This is the case in many schools all over the world where students are praised for their performance on the sports fields and not in the classroom. The question one has to ask him or her is what are students actually sent to school for is it to succeed on the sports field or is it to achieve in the classroom. Many say that it should be a careful and equal balance between the two, yet very often it leans too much in favor of sport. This is when schools start getting the attitude that sport comes first and work comes second. Average students that are good at sport are given scholarships instead of the knowledge hungry hard workers who want to succeed in life not sport. People that achieve in academics or another non-sporting activity are made to feel stupid and are considered an ââ¬Å"outsiderâ⬠or a ââ¬Å"Geekâ⬠by the other students. This is not right and must be stopped. In closing I would like to say something to all of those who this essay may concern. Very few of you will get through life by scoring tries. Truly great men will succeed in life by score knowledge. Creative Writing
Friday, April 10, 2020
How to Write an iELTS Agreement Disagree Essay Sample Answer
How to Write an iELTS Agreement Disagree Essay Sample AnswerThis iELTS agree disagree essay sample answer will help you discover whether you are a hard-worker or just an inferior human being. Are you content with how well you do on your exams? This is definitely a question to answer because you have probably spent quite a bit of time studying to prepare for this test, right?Why should you know how to write an iELTS agree disagree essay sample answer that is completely honest and accurate? There are so many people out there who do not have what it takes to write a good academic essay and they are being passed over for those who are. The majority of people do not write excellent essays.You will not be passing this type of test because you are too lazy to write an iELTS agree disagree essay sample answer. It is not enough to just read about this subject. It is important to remember that the time and effort you put into researching about this subject matter is equally important.The best way to learn how to write an iELTS agreement disagree essay sample answer is to read other students' essays that have been written by these many other students who have already passed the exam. Not all students do this, but for those who do, this is a great way to see what their professors say about the subject matter. Reading as many essays as possible is also a great way to build your credibility within your chosen academic discipline.Your own research is important in writing an iELTS agree disagree essay sample answer. Make sure you don't just go with what you read and see about your subject. Remember that the actual test involves an honest assessment of your performance.When the test taker actually takes the test, he or she is able to draw upon many different aspects from other students' opinions and personal experiences to arrive at his or her own subjective judgments. This is why you need to consider different aspects from various viewpoints in order to come up with a well-wri tten iELTS agree disagree essay sample answer. It is much better to know that your essay was not rushed through than to realize that it was rushed.If you do not learn how to write an iELTS agree disagree essay sample answer, then you may not pass the exam. So pay attention and learn how to write an iELTS agree disagree essay sample answer if you want to show up to the test with the confidence you deserve.
Saturday, March 21, 2020
full metal jacket essays
full metal jacket essays American Society has a past history of negative qualities. These qualities are exposed in the film Full Metal Jacket by Stanley Kubrick. This is seen throughout his Vietnam Film war film. The qualities are seen through the portrayal of violence, sexism, and racism in the film. All of these characteristics are still in American Society today. There still is a constant amount of hate among people in American society. Violence, racism and sexism are all different ways of portraying hate in American society. Violence is portrayed through much of the film. Violence can be seen in many different ways. It could be seen through verbal abuse, drugs or even sex. The film portrays a lot of deaths between soldiers. At one point in the film Pyle the (a main character in the film) shoots his own commanding officer in the chest. He does this because he hated his commanding officer. He felt he was being pushed around and couldnt take anymore of his bad mouthing comments. So in retaliation he killed his own commanding officer. This shows that no one can be trusted not even an army soldier. This violence is commonly seen in American society. A common view of American society is no one can be trusted. After he shoots his commanding officer he takes his own life with the same weapon. This depicts that American society is irrational with decisions. Pyle sensuously took his life because he killed his commanding officer. He knew that he would suffer because of the death that he had caused. So he cowardly took his own life. Sexism is also portrayed throughout the film. In American society women are characterized as a minority. They are seen as lesser people because of their body make and there past roles in American society. In the film the soldiers are told to name their guns. The fire arms were told to be named a female name. The guns are used and abused by the soldiers in the film. They are used for one purpose, and...
Wednesday, March 4, 2020
The secrets to writing effective subheadings
The secrets to writing effective subheadings The secrets of effective subheadings Its easy to treat subheadings as a token afterthought once youve gone through the hard work of actually writing your document. But its worth paying more attention to them than that. They can be an effective tool in drawing your reader in to your full text or helping them find your most important points. Watch the video to find out how: Cant watch the video now? Heres the transcript: Guide the way with subheading signposts You know how it is. Youve written your document. Now you want people to read it (or what was the point?). You probably know no one wants to look at a big block of text, so you break it up. Good start. But thats not enough, is it? No, you also need signposts ââ¬â like subheadings. Well, that looks better already. And subheadings dont just help your writing look good and your documents more inviting. They can work much harder than that. More on that in a minute. But first, a word of warning. Far too often, people write subheadings like these: Background Our experience Recommendations Background: What does that tell you about whats coming? Not much. Our experience: Is that specific? Not really. Recommendations: Are you engaged by this? Do you want to follow these signposts? Probably not. If youre trying to find your way in the world, a signpost will be no help at all if it doesnt actually tell you what its pointing to. And, just like signposts youd follow to get somewhere, your subheadings have to be specific. They have to tell your reader exactly whats ahead, to help them get where they need to go. Even better if your subheading signposts make the reader want to go there. For example: Background âžÅ" What you told us Our experience âžÅ" 40 years in the business Recommmendations âžÅ" How well meet your aims So, what techniques can you use to inspire subheadings that not only draw your reader in but also lead them through your document? Well, remember: well-written subheadings can make your reader want to dive in. So try some of these techniques. Direct Interest Verbs Evoke curiosity with a question Insight (to expand on) Numbers Play on words (if appropriate) Short (ish) Make sure your subheadings are direct and to the point. Corporation tax rate reduced Say something that will be of interest to the reader. How to expand our customer base Try using verbs ââ¬â remember, those are the ââ¬Ëdoingââ¬â¢ and ââ¬Ëbeingââ¬â¢ words. Doing so sounds dynamic and might even encourage action in some cases. Industry achieves positive change Evoke curiosity with a question. Ready for the low-carbon future? Give an insight that youââ¬â¢ll expand on in the following section. Real estate to outperform Try including a number ââ¬â a technique often used online, which lets your reader know exactly how much information to expect. Five ways to combat climate change And theres a PS You can use a play on words ââ¬â but only if you think itââ¬â¢s appropriate to the tone of your document and the intended reader. Face the storm with catastrophe bonds And finally: remember to keep your subheadings shortish. They should be long enough to be meaningful but short enough to be understood and absorbed quickly. So, try some of these techniques for signposting your next document and see how far it takes you. To sum up Remember, the best subheadings will read like an overview of your document ââ¬â but they should also be compelling enough to encourage readers to dive in to the main copy. If you write online content, like blog posts, remember that website visitors do tend to skim-read a page before deciding whether to stay on it. The right subheadings could help tip the balance in your favour. Help your readers navigate In an ideal world, your documents and emails would never be skim-read. But, realistically, some of your time-pressed colleagues or clients will have to do just that. In which case, well-chosen subheadings will at least give them a summary and help them quickly find the most relevant parts. Find your route Subheadings can also help you with your writing process: try coming up with them as part of the planning stage before you write the body of the document, when youre deciding the structure. Or, if you prefer, you could read through the summary your subheads make after youve finished the document to double-check its structure: did you pick the best route? You can then adjust the order if necessary (but dont forget to make sure the text still flows logically). Keep it appropriate Just like anything else you write, judge the suitability of your subheadings against the tone of the document and what you know about the reader. This post is an extract from a lesson in our online-learning programme, Emphasis 360, which is designed to transform your writing step by step, in practical, bite-sized lessons. You can try it out for free here.
Monday, February 17, 2020
Corrections- Strategic Plan Essay Example | Topics and Well Written Essays - 1000 words
Corrections- Strategic Plan - Essay Example The Tasmanian Correction prison institutionââ¬â¢s mission is to make a valid contribution towards a safer and better Tasmania. This it aims achieving through the ensuring of a secure and safe containment of inmates and the provision of opportunities to the inmates for rehabilitation community engagement as well as personal development (Taylor, 2009). The Tasmanian Correction Prisonââ¬â¢s values are direct. They require that the institution continue committing itself to the best principled leadership as well as embracing sets of core values that are directed at guiding the stakeholdersââ¬â¢ behavior. This the institution aims to achieve through: Collaboration: to enhance a communal sense of belonging, everyone at Tasmanian is expected to support a mutual understanding of ideas, an open exploration of all our differences, as well as works together constructively and cooperatively with all the stakeholders alike. Technology: this is aimed at develop and ensuring the best information technology strategy, as well as implement systems that are capable of managing the current and the anticipated growth needs (Richards & Lyneham, 2010). Crime prevention as well as safety: this is aimed at the development of a comprehensive crime prevention program, which aid in the establishment of evidence based. This will then aid in the determination of the impact of offender and related programs within the institutions as well as the community, in order to reduce victimization and criminality (Richards & Lyneham, 2010). Transparency, outreach and partnerships: the institution is open to entering partnerships, as well as the development of meaningful programs alongside the processes of promoting a shared responsibility for the safety of the community (Richards & Lyneham, 2010). Tasmanian institution is known to be a secure facility, in which minors are dedicated as delinquents. The institutionââ¬â¢s aim is prepare convicted people for a successful community
Monday, February 3, 2020
Policy Issue Paper Essay Example | Topics and Well Written Essays - 500 words
Policy Issue Paper - Essay Example The energy security is a very vital issue and deserving of its inclusion in the State of the Union address because it is concerned with the most valuable component of American life, - the energy which fuels the entire US nation, from the west to the east coast, to life. Without this energy source, life in America and everywhere in the world will virtually halt to a standstill. Oil is the chief energy source of the United States and not surprisingly, US is the top oil user in the world, guzzling 20, 588,000 barrels of oil per day according to a 2006 statistic (EIA 1). The problem however with this valuable fossil fuel is that not only is it a potential powerful political tool but that its very availability is now in question. There are claims that oil world resources are dwindling although some quarters like the Cambridge Energy Research Associates are disputing this CERA 2006). It can be fairly said however that the issue of global warming is by now beyond dispute although largely still unacknowledged. Recent scientific studies has established that the burning of fossil fuel emits carbon dioxide to the atmosphere and, along with other greenhouse gases, prevents sunlight from being reflected out of the earthââ¬â¢s atmosphere causing global warming. A hot planet in turn, disturbs climate cycles, melts the ice in the north and south poles altering the water-land ratio, and changes ecosystems (NRDC 2007). With these problems, it shouldnââ¬â¢t be a surprise therefore that the President, in talking about energy security, primarily focused on reducing oil consumption and specifically suggested alternatives like the ââ¬Å"funding of technologies that can generate coal power while capturing carbon emissionsâ⬠, increasing ââ¬Å"the use of renewable power and emission-free nuclear power,â⬠ââ¬Å"investing in advanced battery technology and renewable fuels,â⬠creating a ââ¬Å"new
Sunday, January 26, 2020
Fresh Frozen Plasma (FFP) Collection, Preparation and Uses
Fresh Frozen Plasma (FFP) Collection, Preparation and Uses Samuel Good Fresh Frozen Plasma Introduction Fresh Frozen Plasma (FFP) is the name for the liquid portion of human blood, which has been frozen and preserved. It is taken by blood donation and is stored until needed for blood transfusion. FFP has been available since 1941 (Hoffman, et al, 1990), it was used initially as a volume expander (Erber, et al, 2006), but is now used for the ââ¬Å"management and prevention of bleeding in coagulopathic patientsâ⬠(Ho, et al, 2005). The term FFP is confusing as the plasma cannot be frozen as well as fresh at the same time. What the term implies is that the plasma was frozen rapidly after it was taken and therefore can be considered fresh. The plasma, from a transfusion aspect, contains essential components such as fibrinogen, albumin, globulin and coagulation factors. These allow for specific individual components to be transferred to a recipient who is in need. The most efficient and effective way to make optimum use of blood which has been donated, is to separate it into its individual components. This process allows for a ââ¬Å"wider availability of blood productsâ⬠(Spence, et al, 2006) and also reduces the risk patients are exposed to ââ¬Å"transfusion-related risksâ⬠(Erber, et al, 2006). The use of FFP and its individual products has increased tenfold since its first introduction (Hoffman, et al, 1990). One reason for this may be the declining availability of whole blood because of the trend to use component therapy (Spence, et al, 2006). Collection and Storage When a donor gives a unit of whole blood, the blood is then separated into several components parts. These include; packed red blood cells (pRBC), platelets and FFP. If required the FFP can be further divided into cryoprecipitate and something called cryo-poor plasma. Cryo-poor plasma is rarely used as a therapeutic response (Lauzier, et al, 2007). As mentioned previously, plasma is the non-cellular, liquid part of the blood. It is made up of; water, electrolytes and proteins. The proteins include the clotting factors and intrinsic coagulants (Murray, et al, 1995). The plasma is separated from the blood after donation and then frozen. For the plasma to be considered ââ¬Ëfreshââ¬â¢ it must be frozen ââ¬Å"within eight hours of collectionâ⬠(Murray, et al, 1995) and stored at a temperature of minus 18 degrees centigrade or lower. If this fails to happen, the product is known just as ââ¬Ëfrozen plasmaââ¬â¢, which like cryo-poor plasma, is rarely used for therapeutic means. However, to maintain coagulation factors to optimum levels the plasma should be stored at minus 30 degrees centigrade (Lauzier, et al, 2007). FFP can be prepared by separation from whole blood or via plasmapheresis. Plasmapheresis is the name given to a ââ¬Å"broad range of proceduresâ⬠where ââ¬Å"extracorporeal separation of blood componentsâ⬠(Erber, et al, 2006) results in a plasma which is filtered. Preparation To summarise, FFP is collected in citrate-containing anticoagulant solution, frozen within 8 hours and stored at minus 30 degrees centigrade for up to a year. Although every protection is taken to ensure sterility, it is quite possible for the donor to have an asymptomatic bacteraemia at the time of donation (Stanworth, et al, 2004). The bacteria will have its proliferation down-regulated by the plasma being frozen. However, FFP can still sometimes transmit infectious diseases. Therefore, screening and pathogen inactivation may be performed to reduce the risk. FFP contains no RBCââ¬â¢s and also no WBCââ¬â¢s. As there are no WBCââ¬â¢s the plasma is referred to be as being leucodepleted. This is an indication as to why FFP can transmit said diseases. As mentioned pathogen inactivation can be performed and this is done by using either Methylene blue or a solvent/detergent process. The Methylene Blue Technique Methylene blue is a dye that has been shown to be very effective in the inactivation of pathogens. It binds to nucleic acids and, on illumination with white light, singlet oxygen is formed. This then destroys viral DNA and RNA, therefore viral replication cannot take place. Solvent/Detergent Technique This technique is used for the preparation of factors viii and ix as well as immunoglobulins. First, a solvent is added to the plasma which removes the lipid viral envelope. After this is complete, a detergent is added which inactivates the viral contents. The solvent and detergent are then removed by a physical separation technique, in which they are dissolved in oil. Column chromatography can then be used to isolate factors viii and ix. Once any treatment that is required is complete, the FFP is ready for use. It is an accepted practice that FFP is thawed before use (Ho, et al, 2005). The required units of FFP are placed in a water bath set at 30 ââ¬â 37 degrees centigrade for approximately 20 ââ¬â 30 minutes. Von Heyman, et al investigated the effects of 2 different thawing machines and running warm water of 43 degrees centigrade, on the activity of clotting factors, inhibitors and activation markers in FFP. They discovered no significant differences in the activity of coagulation markers over a 6 hour period post thawing. However, a major conclusion found was that, if FFP is immediately transfused after thawing, the product remained rich in clotting factors. Also, if the plasma is left, the activity of said clotting factors decline gradually and therefore FFP should only be maintained at room temperature for up to 4 hours. If thawed FFP is not used within 24 hours it becomes a separate product known as ââ¬Ëthawed plasmaââ¬â¢ (Murray, et al, 1995). Most clotting factors are stable in thawed plasma, however some labile factors, such as v and viii are not. Their degradation actually accelerates whilst the plasma is in a liquid state (Lauzier, et al, 2007). The only main advantage of having thawed plasma readily available, is that it can be transfused rapidly if a severely injured patient requires it. FFP Blood Type Specific It is widely accepted that O negative is the universal donor for pRBCââ¬â¢s, however for FFP this isnââ¬â¢t the case. A and B antigens of the blood are located on the red cells themselves. Type O individuals are devoid of these proteins on their red blood cells. Plasma does not contain RBCââ¬â¢s, but it contains antibodies to the corresponding absent protein. An example of this is: Type A individual has Anti-B antibodies in their blood. Type O plasma has both Anti-A and Anti-B antibodies and is incompatible with about 55 percent of the population. An individual with type AB blood has neither Anti-A nor Anti-B antibodies. This makes the AB plasma ideal for universal use when the blood type of the patient is unknown. The Rh status is irrelevant because any plasma with Anti-D is destroyed at the manufacturing stage. Recipient blood Acceptable blood groups of donor plasma O O,A,B,AB A A,AB B B,AB AB AB The major problem with blood type AB is that the percentage of the population which has it is only 4 percent. Therefore it is better to use FFP which is blood type compatible, which will be determined at the blood bank. Usage There are very few actual specific needs for the use of FFP (Spence, et al, 2006). Usually FFP is used to treat ââ¬Å"deficiencies of coagulation proteins where specific factor concentrates are unavailableâ⬠(Hoffman, et al, 1990). Coagulation deficiencies can occur in a variety of different clinical situations. These include massive blood loss, surgery, and infection or acquired multiple coagulation factor deficiencies. Examples of FFP usage: Replacement of isolated factor deficiencies Reversal of Warfarin effects Massive blood transfusion Antithrombin III deficiency Treatment of immunodeficiency Treatment of thrombotic thrombocytopenic purpura Treatment of Disseminated intravascular coagulation Replacement of isolated factor deficiency FFP can be used to heat deficiencies of factors II, V, VII, IX, X and XI. It is only chosen as a treatment when no specific component therapy is available. Certain factors require a different haemostatic level, for example; severe factor X deficiency only requires a factor level of about 10 percent. Therefore FFP has a range of success when treating factor deficiencies. Reversal of Warfarin effect If a patient is being treated with Warfarin, they have been shown to be deficient in ââ¬Å"functional vitamin K dependent coagulation factors II, VII, IX and Xâ⬠(Spence, et al, 2006). Usually vitamin K will be administered, however anticoagulated patients will be actively bleeding, and therefore FFP can be used. Massive blood transfusion The use of FFP as a treatment on massive blood transfusion has increased over the decades. Massive bleeding is defined as ââ¬Å"the loss of one blood volume within 24 hoursâ⬠or as ââ¬Å"50 percent blood loss within 3 hoursâ⬠or a ââ¬Å"bleeding rate of 150 ml/minuteâ⬠(Lauzier, et al, 2007). It is indicated for use in patients who have documented blood clotting abnormalities after large blood loss and who are in need of urgent treatment. This is due to the fact that in most emergency situations it is unacceptable to wait hours for lab results to be returned. Antithrombin III deficiency FFP is sometimes used as a source of Antithrombin III in people who are deficient of this inhibitor. Especially if the patients are undergoing surgery or who use Heparin to treat thrombosis. Treatment of Immunodeficiency FFP has been used in children and adults with a humoral immunodeficiency as a source of immunoglobulin. It is also sometimes used for infants when parental nutrition is lacking, and they are suffering with severe protein losing enteropathy (Erber, et al, 2006). Treatment of thrombotic thrombocytopenic purpura The treatment recommended for this condition is a daily plasma exchange (Murray, et al, 1995). Prompt intervention is indicated if development of neurological abnormalities start to appear. This plasma exchange usually continues for at least 2 days after remission (Ho, et al, 2005). Treatment of Disseminated intravascular coagulation Disseminated intravascular coagulation (DIC) is a syndrome where the control of the coagulation system becomes disturbed and out of control. This is usually due to pro-coagulants being dispersed into circulation (Stanworth, et al, 2004). Most of the time this happens secondary to a disease or disorder, such as cancer. In the presence of DIC, fibrinogen, platelets and coagulation factors V and VIII become rapidly depleted. FFP is given as treatment to prevent further problems or progression. Treatment usually involves a patient being infused with a single line of FFP and then coagulation tests performed to assess the clinical benefit (Stanworth, et al, 2004). There are also some conditional uses where FFP can be used but is not the first choice treatment, such as liver disease and Paediatric use. If patients have an abnormal coagulation profile and are suffering from liver disease, they can be treated with FFP. There is varying success and treatment must be monitored by regular transfusion coagulation tests. Clotting times of infants have been shown to be longer than that of adults (Murray, et al, 1995), and even longer in premature babies (OShaughnessy, et al, 2004). Vitamin K deficiency is the most common cause of neonatal bleeding (Murray, et al, 1995). FFP can be used to counter the effects if required. In the case of babies suffering from haemorrhagic disease of the newborn, FFP can be used as treatment. But only if the ââ¬Å"chance of bleeding is greater than the risk of harmful reactionsâ⬠to the treatment with FFP (Lauzier, et al, 2007). Risks As with any transfusion there is a risk of infection, the main risks identified include: Disease transmission Excessive intravascular volume Anaphylactoid reactions Alloimmunisation Transfusion related acute lung injury The risks associated with viral infectivity of FFP are similar to that of whole blood and RBCââ¬â¢s. As mentioned earlier this risk can be countered by photochemically treating the plasma. Allergic reactions that occur in response to FFP transfusion vary in severity from ââ¬Å"hives to fatal non-cardiac pulmonary oedemaâ⬠(Stanworth, et al, 2004). Transfusion relate acute lung injury (TRALI) is defined as a ââ¬Å"new episode of acute lung injury within 6 hours of complicated therapyâ⬠(OShaughnessy, et al, 2004). It manifests as severe respiratory problems, including hypoxia and other symptoms linked to pulmonary oedema. Symptoms will usually subside 2 days after ceasing FFP treatment (Stanworth, et al, 2004). Alloimmunisation can occur if Anti-Rh antibodies are formed after treatment with FFP. To counter this, plasma containing Anti-D antibodies should not be given to an RhD-positive recipient. There has also been reported incidences of post-transfusion Hepatitis, and depends on a number factors, including donor selection. Also with any intravenously transfused fluid, there is a chance of hypervolemia which could lead to cardiac failure, therefore administration of FFP should not be given in excessive doses. Below is a suggested dosage breakdown: Volume of 1 Unit Plasma: 200-250 mL 1 mL plasma contains 1 u coagulation factors 1 Unit contains 220 u coagulation factors Factor recovery with transfusion = 40% 1 Unit provides ~80 u coagulation factors 70 kg X .05 = plasma volume of 35 dL (3.5 L) 80 u = 2.3 u/dL = 2.3% (of normal 100 u/dL) 35 dL In a 70 kg Patient: 1 Unit Plasma increases most factors ~2.5% 4 Units Plasma increase most factors ~10% Figures taken from (http://reference.medscape.com/drug/ffp-octaplas-fresh-frozen-plasma-999499) Conclusion In conclusion, FFP can be used as an effective treatment for a number of different clinical issues. It also does not come without risk and therefore FFP should be collected, stored, prepared and used in an efficient and safe manner. Below I have summarised the administration of FFP. FFP (Fresh Frozen Plasma) Volume: 240-300ml (mean 273ml) Storage: designated temperature controlled freezer. Core temperature -30 o C Shelf life: 24 months (frozen) Must be ABO compatible, but Rh is not necessary to be considered for transfusion and no anti D prophylaxis is required if Rh-D negative patients receive Rh-D positive FFP. Prior to the transfusion FFP must be thawed under controlled conditions using specifically designed equipment. Thawing usually takes approximately 15-30 minutes Once thawed, FFP must not be re-frozen and should be transfused as quickly as possible. Post-thaw storage results in a decline in the quality of coagulation factors. If stored at 4 degrees centigrade post thawing (in a designated temperature controlled refrigerator), the transfusion must be completed within 24 hours of thawing. Pooled solvent-detergent treated plasma is also commercially available Dose: typically 10-15ml/kg. This dose may need to be exceeded in massive haemorrhage depending on the clinical situation and its monitoring (BCSH 2004) Typical infusion rate 10-20ml/kg/hr (approximately 30 minutes per unit) Rapid infusion may be appropriate when given to replace coagulation factors during major haemorrhage. There is anecdotal evidence that acute reactions may be more common with faster administration rates. (http://reference.medscape.com/drug/ffp-octaplas-fresh-frozen-plasma-999499) REFERENCES Erber WN, Perry DJ: Plasma and plasma products in the treatment of massive hemorrhage. Best Pract Res Clin Haematol 2006, 19:97-112 Hewson JR, Neame PB, Kumar N, Ayrton A, Gregor P, Davis C, Shragge BW. Coagulopathy related to dilution and hypotension during massive transfusion. Crit Care Med. 1985;13(5):387-391. Ho AM, Karmakar MK, Dion PW. Are we giving enough coagulation factors during major trauma resuscitation? Am J Surg. 2005;190(3):479-484. Hoffman M, Jenner P. Variability in fibrinogen and Von Willebrand factor content of cryoprecipitate.à Brief Sci Rep. 1990;93(5):694-697. Lauzier F, Cook D, Griffith L, Upton J, Crowther M: Fresh frozen plasma transfusion in critically ill patients. Crit Care Med 2007, 35:1655-1659. Leslie SD, Toy PT. Laboratory hemostatic abnormalities in massively transfused patients given red blood cells and crystalloid. Am J Clin Pathol. 1991;96(6):770-773. Murray DJ, Olson J, Strauss R, Tinker JH. Coagulation changes during packed red cell replacement of major blood loss. Anesthesiology. 1988;69(6):839-845 Murray DJ, Pennell BJ, Weinstein SL, Olson JD.Packed red cells in acute blood loss: dilutional coagulopathy as a cause of surgical bleeding. Anesth Analg. 1995;80(2):336-342. OShaughnessy DF, Atterbury C, Bolton Maggs P, Murphy M, Thomas D, Yates S, Williamson LM, British Committee for Standards in Haematology, Blood Transfusion Task Force: Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant. Br J Haematol 2004, 126:11-28. Spence RK: Clinical use of plasma and plasma fractions. Best Pract Res Clin Haematol 2006, 19:83-96. Stanworth SJ, Brunskill SJ, Hyde CJ, McClelland DB, Murphy MF: Is fresh frozen plasma clinically effective? A systematic review of randomized controlled trials. Br J Haematol 2004, 126:139-152 Tieu BH, Holcomb JB, Schreiber MA. Coagulopathy:its pathophysiology and treatment in the injured patient. World J Surg. 2007;31(5):1055-1065 http://en.wikipedia.org/wiki/Fresh_frozen_plasma http://www.psbc.org/therapy/ffp.htm http://reference.medscape.com/drug/ffp-octaplas-fresh-frozen-plasma-999499 http://ccforum.com/content/14/1/202
Subscribe to:
Posts (Atom)