International Forum on the Management of Major Haemorrhage: Summary

Haematological management of major haemorrhage: a British Society for Haematology Guideline

“…There is a spectrum of severity and presentation of major haemorrhage, which at one extreme is seen as acute major blood loss associated with haemodynamic instability and risk of shock, but also those in whom the bleeding appears controlled but still require 'massive' transfusion. Variable definitions of major haemorrhage continue to be used in the literature based on volumes of blood loss, or volume of blood transfused over a period 9 . These are retrospective definitions, arguably arbitrary, and difficult to apply in the acute situation.…”

“…Variable definitions of major haemorrhage continue to be used in the literature based on volumes of blood loss, or volume of blood transfused over a period. 9 These are retrospective definitions, arguably arbitrary, and difficult to apply in the acute situation. The current trend is towards the use of a more anticipatory or dynamic definition for major haemorrhage, based on the clinical status of the patients, their physiology and response to resuscitation therapy, 10 e.g., heart rate >110 beats/min and/or systolic blood pressure <90 mm Hg.…”

“…(1B) We suggest fibrinogen supplementation should be given if fibrinogen concentrations fall below 1.5 g/l (non‐pregnant women). (2B) If major bleeding is on‐going, we suggest using platelet transfusions to maintain platelet counts at >50 × 10 9 /l. (2C) We suggest that VHAs are used to guide transfusion therapy in cardiac surgery, although for other clinical settings of major bleeding (e.g.…”

Patient blood management using dedicated personnel in the operating room—you get what you pay for

“…It is evidenced‐based through use of thromboelastography (TEG) to guide both transfusion and antifibrinolytic therapy in cases of controlled massive haemorrhage 1 . A recent international forum on management of major haemorrhage shows that TEG is gaining traction in this area 2 . In Israel and Germany transfusions are guided by TEG and rotational thromboelastometry respectively.…”

“…1 A recent international forum on management of major haemorrhage shows that TEG is gaining traction in this area. 2 In Israel and Germany transfusions are guided by TEG and rotational thromboelastometry respectively. Another evidenced-based but underutilised technique is the swab wash.…”