Blood and Coagulation Support in Trauma Care

Abstract

Injuries are common and account for almost 15% of all blood use in the U.S. The historic view that the coagulopathy associated with severe injury was largely dilutional is being replaced by epidemiologic and molecular evidence for a distinct syndrome of trauma-associated coagulopathy. This coagulopathy of trauma is the sum of the effects of blood loss and dilution, coagulation factor and platelet consumption, hypothermic platelet dysfunction and acidosisinduced decreases in coagulation factor activity, and fibrinolysis. Preventing the coagulopathy of trauma is best accomplished by preventing injury and hypothermia. Treating the coagulopathy of trauma requires its early recognition, prompt control of hemorrhage with local and systemic treatments, including in some patients the use of plasma instead of crystalloid solutions, and the prompt treatment of acidosis and hypothermia. The planned early use of allogenic plasma to treat many tens of thousands of massively transfused patients each year creates new demands for the immediate availability and improved safety of plasma products.

Increased Mortality Associated With the Early Coagulopathy of Trauma in Combat Casualties

“…[12][13][14] This unique coagulopathy is likely caused by blood loss, acidosis, hypothermia, consumption, fibrinolysis, and dilution. [15][16][17][18][19][20][21] Another recently hypothesized physiologic mechanism for traumatic coagulopathy is tissue hypoperfusion, measured through base deficit (BD), resulting in the release of protein C, an anticoagulant, which circulates in the plasma. 20 In contrast to civilian trauma where blunt injuries represent approximately 90% of admissions, penetrating injuries are responsible for more than 90% of the injuries seen in the ongoing war in Iraq and Afghanistan.…”

Coagulation management in the treatment of multiple trauma

“…Daraus ent wickelte sich die Idee, bei tastbarem Radia lispuls niedrige Blutdruckwerte zu tolerie ren, solange keine chirurgische Blutstil lung gewährleistet ist. Dies geschieht pri mär durch eine restriktive Volumengabe [33,73]. Welche Flüssigkeit und ob Kris talloide oder Kolloide dabei benutzt wer den sollen, ist derzeit nicht eindeutig zu klären [83].…”

Disseminated Intravascular Coagulation in Obstetrics: Ethiopathogenesis and up to date Management Strategies

“…Similar to trauma patient, in postpartum bleeding, the severe amount of blood loss and subsequent consumption of coagulation factors is held responsible for the development of DIC (14) . In pre-eclampsia, the maternal inflammatory response formed against trophoblasts results in a systemic endothelial dysfunction.…”