***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Early changes in coagulation were found in patients following a paracetamol overdose . Low levels of clotting factors II , V and VII were present within 24 hours of the overdose . As the levels of factor II correlated with plasma fibrinogen values at this time , it is possible that they were consumed in the process of intravascular coagulation , although this was not supported by the presence of raised titres of fibrin degradation products . The prothrombin time ratio was greater than 2 - 2 within 30 hours of ingestion of the overdose in all patients who eventually died , whereas it was less than this in those developing only moderate liver damage . The administration of fresh frozen plasma to patients did appear to reduce the maximum abnormality of the prothrombin time ratio , which was significantly less three days after the overdose in the group receiving fresh frozen plasma . However , the coagulation disturbance was of short duration , and the prothrombin time ratio had also returned to normal within one week of the overdose in the control patients , and the administration of fresh frozen plasma did not appear to reduce the morbidity or mortality in the treated patients A prospect i ve study to evaluate efficacy and safety of partial exchange blood transfusion ( PEBT ) with normal saline or plasma was conducted in 30 symptomatic polycythemic newborns . Babies were r and omly assigned to receive PEBT either with normal saline or plasma . Both groups were comparable in terms of birth weight , gestational age , preexchange hematocrit and viscosity . A significant fall in hematocrit and viscosity was noticed at 6 hours following PEBT which persisted even at 24 hours ( P < 0.001 ) . Hematocrit and viscosity were comparable in the two groups at 6 and 24 hours ( p > 0.05 for both ) . Majority of babies became asymptomatic after 24 hours of PEBT , but one baby in the saline group remained polycythemic and symptomatic requiring repeat PEBT . No complications related to the procedure were encountered in the two groups . Partial exchange with normal saline was as effective and safe as plasma in symptomatic polycythemic newborns Thrombotic thrombocytopenic purpura ( TTP ) is a potentially fatal disease that is treated with plasma exchange and typically with replacement with fresh frozen plasma ( FFP ) . This approach results in an approximate 50 % response rate following 1 week of therapy and 80 % survival . Cryoprecipitate poor plasma ( CPP ) is plasma from which the cryoprecipitate fraction is removed . CPP has been reported to be successful as salvage therapy in refractory TTP and has been suggested to be superior to FFP in retrospective studies . The present report compares initial therapy of TTP with exchange using replacement with either FFP or CPP in a multi-institutional prospect i ve r and omized study performed by the North American TTP Group ( NATG Group ) from 1993 to 1995 . Initial therapy also included corticosteroids . Antiplatelet drugs or vinca alkaloids were not employed . A severity score index , response score , and individual clinical parameters ( platelet count , LDH x upper limit of normal , hemoglobin level , and creatinine ) were compared at their nadir or peak values , baseline , and days + 6 and + 13 of therapy . Thirteen patients were r and omized to FFP exchange and 14 to CPP exchange . Results were equivalent for all parameters . Survival was equal with three deaths in each group . These data indicate that the efficacy of FFP and CPP are the same in the initial treatment of TTP in adults OBJECTIVES To assess the benefits of withdrawn autologous plasma , the objective of this study was to investigate whether withdrawal of acutely performed platelet-rich or platelet-poor plasmapheresis allays changes in the protein C-thrombomodulin and fibrinolytic systems after retransfusion secondary to cardiopulmonary bypass ( CPB ) . In addition , the study attempted to determine the influence of acute plasmapheresis ( APP ) on the protein C-thrombomodulin and fibrinolytic systems as well as on homologous blood consumption and perioperative blood loss in elective aortocoronary bypass patients . DESIGN The investigation was scheduled as a prospect i ve , r and omized , unblinded study . SETTING This single investigation was conducted in the Department of Anesthesiology and Intensive Care Medicine at a university in Germany . The study protocol was approved by the Ethics Committee of the hospital , and informed consent was obtained . PARTICIPANTS Sixty male patients scheduled for elective coronary artery bypass grafting with extracorporeal circulation were included in the study . INTERVENTIONS APP was performed between induction of anesthesia and incision , collecting either 10 mL/kg of autologous platelet-poor plasma ( PPP patients , group 1 ; n = 20 ) or the same amount of platelet-rich plasma ( PRP patients , group 2 ; n = 20 ) . Patients of group 3 ( n = 20 ) had no APP ( control group ) . All patients were maintained on their usual regimen of cardiac drugs until the morning of surgery . To preserve hemodynamic stability and restore the intravascular oncotic pressure , the separated plasma was replaced by infusion of an equal amount of hydroxyethyl starch solution ( HES ) ( 6 % HES , molecular weight 2 x 10(5 ) , substitution rate 0.5 % ) . In all operations , the same surgical procedure was chosen . For all patients , induction and maintenance of anesthesia were similar , consisting of weight-related doses of fentanyl ( 35 micrograms/kg ) , midazolam ( 0.65 mg/kg ) , and pancuronium bromide ( 0.15 mg/kg ) . The lungs of all patients were mechanically ventilated during the first 5 hours after the end of the operation . MEASUREMENTS AND MAIN RESULTS All patients had serial coagulation studies including antithrombin ( AT ) III-activity , prekallikrein , factor XII , and immunologic tests such as thrombin-antithrombin III ( TAT ) , fibrinopeptide A ( FPA ) , protein C and S ( PC and PS ) , thrombomodulin ( TM ) , tissue-plasminogen-activator ( t-PA ) , plasminogen-activator-inhibitor ( PAI 1 ) , fibrinopeptide B beta 15 - 42 ( FPB beta 15 - 42 ) , D-dimers , and hemoglobin and platelet counts determined intraoperatively and postoperatively . Chest tube drainage and transfusion requirements were recorded . APP had no negative effects on the quality of PPP and PRP plasma . The platelet count of the withdrawn plasma was 28 + /- 12 x 10(9)/L ( PPP group ) and 245 + /- 36 x 10(9)/L ( PRP group ) . At the end of the operation ( after retransfusion of autologous plasma ) and on the morning of the first postoperative day , platelet counts were significantly higher ( p > 0.05 ) in the PRP than in the PPP and control groups . Plasma concentrations of TAT and FPA increased ( ranging from + 185 % to + 340 % from baseline values ) and AT III-activity , PC , PS , and TM antigen decreased ( ranging from -8 % to -55 % from baseline values ) to a different extent for all three groups throughout CPB . t-PA-activity increased with a maximum at the end of CPB ( PPP group , 6.9 + /- 1.5 IU/mL : PRP group , 3.8 + /- 0.8 IU/mL ; control group , 10.9 + /- 2.8 IU/mL ) . Fibrin and fibrinogen degradation markers such as D-dimers and FPB beta 15 to 42 occurred in peak concentrations after neutralization of heparin by protamine . Only PRP patients showed baseline concentrations of coagulation parameters the next morning ( p < 0.05 ) . Total postoperative blood loss within the first 24 hours reached 482 + /- 273 mL ( PRP group ) , 775 + /- 256 mL ( PPP group ) , and 948 + /- 342 mL in the control group ( p < 0.05 ) . ( ABSTRACT TRUNCATED In thrombotic microangiopathies hemolytic uremic syndrome and thrombocytopenic purpura , plasma exchange ( PE ) therapy using fresh frozen plasma is st and ard . In almost 20 % of the patients , however , this approach is ineffective . This prospect i ve , r and omized study for the treatment of patients with thrombotic microangiopathies ( PRODROMI ) compares PE with fresh frozen plasma ( A ) and cryosupernatant ( B ) .  The participating centers were the University Clinics of Freiburg , Hamburg , Düsseldorf , Essen , Göttingen , Mannheim , Ulm , Jena , Tübingen , Würzburg , Kreiskrankenhaus Offenburg , Städt Klinikum Karlsruhe , and Horst-Schmidt Kliniken in Wiesbaden , Germany . Patients ( 18 to 80 years ) were diagnosed by the individual centers based on clinical and laboratory findings ( thrombocyte/fragmentocyte count , hemoglobin , serum creatinine , haptoglobin and lactate dehydrogenase levels ; negative Coombs-test is obligatory ) . HIV infection , bone marrow , or solid organ transplantation were exclusion criteria . After written consent , patients were r and omized in the A or B group . All patients received 1.5 mg/kg methylprednisolone as a basic therapy . The first PE always was performed with fresh frozen plasma ( 50 ml/kg ) . A minimum of 5 and a maximum of 10 PEs were required . Thrombocyte count above 150,000/microl was considered to be a successful therapy . Treatment failure was defined as not responding to 10 PE with a thrombocyte count above 150,000/microl or a fall below this value within 30 days after stopping PE . Patients with clinical and laboratory signs of thrombotic microangiopathy occurring later than 30 days after having stopped PE were considered to have a relapse . Primary endpoints were survival , intensity of required PE sessions ( duration , volume , and number ) , and relapse rate . Follow-up of clinical outcome was 2 years ; von Willebr and Factor ( vWF ) , vWF-cleaving-protease activity , and Factor H were determined The use of partial plasma exchange transfusion in newborns with polycythemia and hyperviscosity was evaluated . Ninety-three infants with polycythemia and hyperviscosity were r and omly assigned to receive either partial plasma exchange transfusion or symptomatic treatment ; the infants were matched with control infants without polycythemia . Neonatal course and outcome at 1 and 2 years were evaluated for each of the three groups . Polycythemic infants had more fine motor and speech problems at 1 year of age than did control infants . At 2 years of age , polycythemic infants had more gross motor delays , neurologic diagnoses , fine motor abnormalities , and speech delays than did the control infants . There was no significant difference at 1 year between the polycythemic infants who had received partial plasma exchange transfusion and those given only symptomatic care . At 2 years , the group receiving partial plasma exchange transfusion had fewer neurologic diagnoses and fine motor abnormalities Seventy three preterm infants weighing less than 1500 g or less than 32 weeks ' gestation , or both , were allocated r and omly to treatment ( fresh frozen plasma 10 ml/kg on admission and at 24 hours of age ) or control groups . Fifteen ( 41 % ) out of 37 control patients  sustained intraventricular haemorrhage compared with five ( 14 % ) of 36 patients receiving treatment ( X2 = 5.24 , P = 0.022 ) . No difference was found in coagulation factors measured at birth or at 48 hours of age in both groups . Fresh frozen plasma appears to have a beneficial effect in the prevention of intraventricular haemorrhage Colloid infusions are often given to treat hypotension in preterm infants . The aim of this work was to assess whether it was the amount of protein or the volume of the colloid infused which accounted for the observed increase in blood pressure .  Sixty preterm infants were r and omised ( 20 in each group ) to receive 5 ml/kg 20 % albumin , 15 ml/kg fresh frozen plasma , or 15 ml/kg 4.5 % albumin . All infusions were given at a rate of 5 ml/kg/hour in addition to maintenance fluids . The infants were r and omised when hypotensive ( systolic blood pressure less than 40 mm Hg for two hours ) . There was no significant difference in the blood pressure of the three groups before or one hour after beginning the infusion . The mean increase in blood pressure one hour after completing the infusion , however , was significantly lower in infants receiving 20 % albumin : 9 % compared with 17 % in the group receiving 4.5 % albumin , and 19 % in the group receiving fresh frozen plasma . It is concluded that the volume infused rather than albumin load is important in producing a sustained increase in blood pressure The goals of this multicenter controlled trial were : ( 1 ) to study the short‐term effect of plasma exchange in the Guillain‐Barré syndrome when applied alone within 17 days of onset of the disease ; and ( 2 ) to compare two replacement fluids , diluted albumin and fresh frozen plasma ( FFP ) with regard to efficacy and morbidity . Two hundred twenty patients were included , 11 
    Output:
    
In particular , there is little evidence for the effectiveness of the prophylactic use of FFP .