Hematopoietic function after brain death maintained with the combined administration of vasopressin and catecholamine.
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To elucidate the mechanism of remarkable anemia observed in brain-dead patients that are maintained for a long period, we investigated hematopoietic function after brain death. Brain-dead patients from severe closed head injury without distinct external hemorrhage were studied for myelogram, peripheral blood picture and erythropcietin before and after brain death. Brain-dead patients were maintained with the combined administration of arginine vasopressin and catecholamine. After brain death hemoglobin fell by approximately 4mg/dl, and remained low thereafter. The erythropoietin value was 50.2±19.4mU/ml, which was above the normal range, suggesting that brain-dead patients secreted as much erythropoietin as patients with anemia from other causes. Reticulocyte count was (8.8±4.3)×104/mm3 until 20 days after brain death, but increased remarkably from 21 days after brain death to as high as (25.5±14.6)×104/mm3. Platelet count fell transiently after brain death, then recovered to the normal range at 10 days after brain death, and remained above the normal range thereafter. In myelogram, myelocytes increased significantly in the infection group and non-infection group within 7 days after brain death. Although there was no significant difference between these groups, the segmental form tended to increase in the non-infected group from 8 days after brain death. Brain-dead patients received fluid with a positive water balance of 2, 000ml/day to maintain hemodynamics immediately after brain death. The present study suggests that anemia after brain death is caused by the dilution effect of fluid resuscitation and slow response of erythrocyte production, and that bone marrow function is maintained after brain death.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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