Hemostasis in Massively Transfused Trauma Patients

Independent Contributions of Hypothermia and Acidosis to Coagulopathy in Swine

“…Decreased fibrinogen levels have been described in trauma patients, and the decline of fibrinogen levels have been considered as one of the two most sensitive measures of clinical coagulopathy (the other being platelet counts). 32 Consistently, we observed decreases of approximately 20% in fibrinogen concentration shortly after induction of acidosis. This 20% drop can be amplified by hemorrhage and resuscitation, as occurs in patients after a trauma injury or after surgery.…”

The Use of Fresh Whole Blood in Massive Transfusion

“…[13][14][15][16][17]27 Logistics One of the most pervasive arguments against the use of whole blood is that it is logistically too demanding to be practical, even if indicated. 6,10,25,33 This argument focuses on the recruiting, interviewing and testing of a poorly-defined civilian donor population rather than the processing of blood units. The processing of whole blood into components is clearly more costly of labor, time, and materiel.…”

“…[33][34] In the same way, cryoprecipitate was included because it was readily available, and there is data suggesting that rapid decline in fibrinogen is a significant component of coagulopathy during massive resuscitation and surgery. [33][34] Finally, we encouraged the blood bank to develop a "push" instead of a "pull" mentality to ensure that formalized requirements, requests, and paperwork would not take precedence over delivery of blood products to the bedside of an exsanguinating casualty.…”

“…However, both civilian and military physicians continued to investigate the indications and use of whole blood in the setting of massive transfusion. 7,10,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]44 The clinical situations in which any of these levels of transfusion are needed are imminently life-threatening.…”

“…These complications include quantitative and qualitative thrombocytopenia, dilutional and consumptive coagulopathy, citrate toxicity, hypocalcemia, hyperkalemia, and hypothermia. [25][26][27][28][29][30][31][32][33][34][35][36][37][38] Many of these complications have been attributed to the side effects of component therapy which become exaggerated during massive transfusion. 26 -29,33-34,36,38 These complications have been repeatedly observed, and modern transfusion practice incorporates techniques specifically developed to address these problems.…”