Massive Blood Transfusion

From Anvita Health Wiki

Contents 1 Introduction 2 Pathology 3 Clinical-manifestations 4 Laboratory 5 Management 6 More General Terms 7 Additional Terms 8 References

Introduction

• Replacement of more than one blood volume (10 units of blood) in < 24 hours.

Pathology

• coagulopathy & thrombocytopenia from replacement with erythrocytes & crystalloid (deficiency in platelets & coagulation factors)
• qualitative platelet defect
• diffuse microvascular bleeding from wounds & other traumatized sites
• disseminated intravascular coagulation (may be related to shock)
• systemic fibrinolysis may occur in patients with severe liver disease
• sudden decreases in plasma Ca+2 can occur as a result of infusions of citrated plasma (especially in patients with severe liver disease unable to rapidly clear citrate from circulation)

Clinical-manifestations

• hypotension
• hypothermia

Laboratory

• prothrombin time (PT) & aPTT prolonged
• plasma fibrinogen low
• platelet count: mild thrombocytopenia (50,000-100,000/ uL)
• arterial blood gas: metabolic acidosis

Management

• replacement of blood loss with fresh whole blood*
• prophylactic platelet transfusions NOT helpful
• replace specific factors as indicated by laboratory assessment

• packed red blood cells ( RBC)
• fresh frozen plasma
• platelets

• use of blood warmers

• * generally NOT available

More General Terms

• blood transfusion

Additional Terms

• disseminated intravascular coagulation (DIC)
• hypocalcemia
• systemic fibrinolysis

References

Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998

massive blood transfusion (washout)