Indications for Early Fresh Frozen Plasma, Cryoprecipitate, and Platelet Transfusion in Trauma

Abstract

Early use of plasma and platelets at the upper end of recommended doses appears to reduce the incidence of coagulopathy in massively transfused individuals.

Effect of Plasma and Red Blood Cell Transfusions on Survival in Patients With Combat Related Traumatic Injuries

“…38,39 These guidelines may be appropriate for postoperative bleeding in an otherwise healthy patient but may not be the optimal approach for trauma patients who are hypocoaguable or in shock. 37 A consistent definition of shock according to base deficit values is not well described. We chose to define shock as a base deficit of Ն4 because the normal range of base deficit is Ϫ3 to ϩ3 and recent evidence published in a study of over 800,000 trauma patients that mortality starts to increase at a base deficit above 4.…”

“…10,37,38,42 Each unit of FFP in addition to coagulation factors contains 0.5 g of fibrinogen. 37 Recent studies suggest that fibrinogen administration is essential for achieving hemostasis in patients with significant traumatic injuries [43][44][45][46][47][48] and very likely contributes to the improved outcomes that have been associated with increased transfusion of plasma. 7,49,50 However, the use of plasma as a volume expander is controversial though this practice has been relatively abandoned since the 1940s.…”

“…36 The indications for the use of plasma have been determined by estimates of plasma protein requirements based on calculation, animal studies, and clinical experience during the time when stored whole blood was primarily transfused. 37 Standard indications for the use of plasma have included either a 1 to 2 blood volume loss or an INR greater than 1.5 times above normal in a patient with active bleeding. 38,39 These guidelines may be appropriate for postoperative bleeding in an otherwise healthy patient but may not be the optimal approach for trauma patients who are hypocoaguable or in shock.…”

Perioperative coagulopathy monitoring

“…Therefore, routine laboratory tests consider neither the effect of hypothermia on hemostatic physiology nor the complex interaction of plasma proteins, platelets, and the vessel wall after traumatic or surgical injury [8]. Often, the results of routine hemostatic tests are generally available with a delay of at least 30-60 min; results, therefore, may not be able to provide an accurate picture of the current hemostatic physiology [22]. Hardy et al [23] concluded that bedside monitors of hemostasis are needed urgently for the management of operative and trauma-associated bleeding [10][11][12][13][14][15][16][17][18][19].…”

“…Due to the complex nature of hemorrhage in these settings, physicians require coagulation monitoring strategies sensitive to all major possible pathomechanisms of hemostatic dysfunction. POC coagulation monitoring devices have become available and may ultimately overcome several of the limitations associated with routine coagulation testing [3,8,22,25].…”