Transfusion Management of Trauma Patients

Abstract

The management of massively transfused trauma patients has improved with a better understanding of trauma-induced coagulopathy, the limitations of crystalloid infusion, and the implementation of massive transfusion protocols (MTPs), which encompass transfusion management and other patient care needs to mitigate the “lethal triad” of acidosis, hypothermia, and coagulopathy. MTPs are currently changing in the United States and worldwide because of recent data showing that earlier and more aggressive transfusion intervention and resuscitation with blood components that approximate whole blood significantly decrease mortality. In this context, MTPs are a key element of “damage control resuscitation,” which is defined as the systematic approach to major trauma that addresses the lethal triad mentioned above. MTPs using adequate volumes of plasma, and thus coagulation factors, improve patient outcome. The ideal amounts of plasma, platelet, cryoprecipitate and other coagulation factors given in MTPs in relationship to the red blood cell transfusion volume are not known precisely, but until prospective, randomized, clinical trials are performed and more clinical data are obtained, current data support a target ratio of plasma:red blood cell:platelet transfusions of 1:1:1. Future prospective clinical trials will allow continued improvement in MTPs and thus in the overall management of patients with trauma.

Early massive transfusion in trauma patients: Canadian single-centre retrospective cohort study

“…Finally, recent basic science and clinical research has identified a potentially harmful ''storage lesion'' in transfused red blood cell units. 13,50 These biochemical and physical changes include intracellular 2,3-diphosphoglycerate depletion that decreases oxygen offloading from hemoglobin, a stiffer cell membrane that reduces red blood cell flow through capillaries, and decreased bioavailability of nitric oxide necessary for microcirculatory vasodilation. These alterations, together with other biological substances present in preserved red blood cell units, may reduce oxygen delivery and stimulate inflammatory pathways.…”

“…We selected the 10-year timeframe (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001) for data collection because the hospital's trauma registry and blood bank database included cases from this period and available research personnel could feasibly collect data for identified cases. Although massive transfusion is variably defined, our definition is common 3,13 and has been locally adopted. During the period of the study, the hospital had approximately 450 acute care beds with a median of 664 (range, 467-864) admissions per year due to trauma; 488 (range, 344-628) of the admissions had an injury severity score (ISS) C16.…”

Fixed rate of blood component improves the survival rate of patients in massive transfusion

“…Recent studies have found that early detection of coagulation, early and active intervention of blood component proportion is extremely significant in patients with severe trauma. MT of almost whole blood markedly reduces mortality (32). Therefore, fixed blood component ratios improve the use of blood components and reduce mortality.…”

Efeito da hemodiluição normovolêmica aguda na coagulação sanguínea: comparação entre os testes colhidos de um modelo in vivo e de um modelo in vitro

“…The short period of hypothermia was not enough to cause substantial changes in hemostasis. Planned hemodilution differs from hemodilution secondary to trauma and large blood loss 28 . In planned hemodilution, the blood volume and temperature are maintained, without a large consumption of platelet and coagulation factors.…”