Massive Bleeding and Massive Transfusion

Abstract

Massive bleeding in trauma patients is a serious challenge for all clinicians, and an interdisciplinary diagnostic and therapeutic approach is warranted within a limited time frame. Massive transfusion usually is defined as the transfusion of more than 10 units of packed red blood cells (RBCs) within 24 h or a corresponding blood loss of more than 1- to 1.5-fold of the body’s entire blood volume. Especially male trauma patients experience this life-threatening condition within their productive years of life. An important parameter for clinical outcome is to succeed in stopping the bleeding preferentially within the first 12 h of hospital admission. Additional coagulopathy in the initial phase is induced by trauma itself and aggravated by consumption and dilution of clotting factors. Although different aspects have to be taken into consideration when viewing at bleedings induced by trauma compared to those caused by major surgery, the basic strategy is similar. Here, we will focus on trauma-induced massive hemorrhage. Currently there are no definite, worldwide accepted algorithms for blood transfusion and strategies for optimal coagulation management. There is increasing evidence that a higher ratio of plasma and RBCs (e.g. 1:1) endorsed by platelet transfusion might result in a superior survival of patients at risk for trauma-induced coagulopathy. Several strategies have been evolved in the military environment, although not all strategies should be transferred unproven to civilian practice, e.g. the transfusion of whole blood. Several agents have been proposed to support the restoration of coagulation. Some have been used for years without any doubt on their benefit-to-risk profile, whereas great enthusiasm of other products has been discouraged by inefficacy in terms of blood transfusion requirements and mortality or significant severe side effects. This review surveys current literature on fluid resuscitation, blood transfusion, and hemostatic agents currently used during massive hemorrhage in order to optimize patients’ blood and coagulation management in emergency medical aid.

Complications of Massive Blood Transfusion

“…Transfusion induced acute lung injury (TRALI) occurs within 6 hours of transfusion, but could be delayed up to even 24 hours post transfusion. [8,11] The type of blood product determines the risk of TRALI which could be 1/5000 units of PRBC's, 1/2000units of FFP's, 1/400 units of platelets. Clinically it leads to the development of non-cardiogenic pulmonary edema, severe hypotension and bilateral fluffy in filtrates in the lungs.…”

Cardiac Arrest and Succesful Resuscitation after Massive Bleeding and Massive Blood Transfusion during Hemipelvectomy: Case Report

“…Extensive tissue trauma of surgery and major blood loss are main problems that can be encountered during these operations (1). Massive bleeding (loss of entire blood volume equivalent within 24 hours or loss of 50% of blood volume within 3 hours or continuing blood loss of 150 ml/min, or continuing blood loss of 1.5 ml/kg/min over 20 min) is the major cause of perioperative cardiac arrest in major noncardiac operations in noncardiac patients (2,3). Massive transfusion is defined as the transfusion of more than 10 units of packed red blood cells within 24 hour or replacement of one entire blood volume within 24 hour or transfusion of more than 4 units of packed red blood cells in 1 hour when on-going need is foreseeable or replacement of 50% of total blood volume within 3 hour (4).…”

Massive Blood Transfusion during Revision Total Hip Arthroplasty under Combined Spinal Epidural Anaesthesia

“…However, early recognition of massive haemorrhage and early administration of fresh frozen plasma (FFP) have been reported to reduce mortality (2)(3)(4). Therefore, some countries have recently proposed a new definition for massive haemorrhage, which is different from the current standard definition.…”