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Invited Critique
Nov 2011

Another Bastion of Empiricism Falls?Comment on “Transfusion Criteria for Fresh-Frozen Plasma in Liver Resection”

Author Affiliations

Author Affiliation: Liver Disease and Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California

Arch Surg. 2011;146(11):1299. doi:10.1001/archsurg.2011.307

Adding science to the use of blood and blood products in the military and civilian trauma settings has been an active area of investigation for years. The appropriate use of FFP in the setting of massive blood transfusion requirements is a topic often studied. Interest in these topics has led to the evolution of “transfusion medicine” until it has become a distinct subspecialty. Nevertheless, the appropriate use of FFP after liver resection has not been previously well studied except to document the lack of standards and the significant variability in practice.1 Patients undergoing resection often have varying degrees of underlying liver disease, making it difficult to anticipate the impact of surgery and the possibility of synthetic dysfunction in the hepatic remnant. Despite great interest and effort, to date, no device, measure, or formula has risen to common use that can reliably predict outcomes after major liver resection. As a result, the (unnecessary) use of FFP after something as common as liver resection has remained distinctly inexact and completely empirical—until now, perhaps.

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