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Update on massive transfusion.

Publication ,  Journal Article
Pham, HP; Shaz, BH
Published in: Br J Anaesth
December 2013

Massive haemorrhage requires massive transfusion (MT) to maintain adequate circulation and haemostasis. For optimal management of massively bleeding patients, regardless of aetiology (trauma, obstetrical, surgical), effective preparation and communication between transfusion and other laboratory services and clinical teams are essential. A well-defined MT protocol is a valuable tool to delineate how blood products are ordered, prepared, and delivered; determine laboratory algorithms to use as transfusion guidelines; and outline duties and facilitate communication between involved personnel. In MT patients, it is crucial to practice damage control resuscitation and to administer blood products early in the resuscitation. Trauma patients are often admitted with early trauma-induced coagulopathy (ETIC), which is associated with mortality; the aetiology of ETIC is likely multifactorial. Current data support that trauma patients treated with higher ratios of plasma and platelet to red blood cell transfusions have improved outcomes, but further clinical investigation is needed. Additionally, tranexamic acid has been shown to decrease the mortality in trauma patients requiring MT. Greater use of cryoprecipitate or fibrinogen concentrate might be beneficial in MT patients from obstetrical causes. The risks and benefits for other therapies (prothrombin complex concentrate, recombinant activated factor VII, or whole blood) are not clearly defined in MT patients. Throughout the resuscitation, the patient should be closely monitored and both metabolic and coagulation abnormalities corrected. Further studies are needed to clarify the optimal ratios of blood products, treatment based on underlying clinical disorder, use of alternative therapies, and integration of laboratory testing results in the management of massively bleeding patients.

Duke Scholars

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Published In

Br J Anaesth

DOI

EISSN

1471-6771

Publication Date

December 2013

Volume

111 Suppl 1

Start / End Page

i71 / i82

Location

England

Related Subject Headings

  • Tranexamic Acid
  • Thrombelastography
  • Humans
  • Hemorrhage
  • Blood Transfusion
  • Blood Coagulation Factors
  • Blood Coagulation Disorders
  • Anesthesiology
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

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Pham, H. P., & Shaz, B. H. (2013). Update on massive transfusion. Br J Anaesth, 111 Suppl 1, i71–i82. https://doi.org/10.1093/bja/aet376
Pham, H. P., and B. H. Shaz. “Update on massive transfusion.Br J Anaesth 111 Suppl 1 (December 2013): i71–82. https://doi.org/10.1093/bja/aet376.
Pham HP, Shaz BH. Update on massive transfusion. Br J Anaesth. 2013 Dec;111 Suppl 1:i71–82.
Pham, H. P., and B. H. Shaz. “Update on massive transfusion.Br J Anaesth, vol. 111 Suppl 1, Dec. 2013, pp. i71–82. Pubmed, doi:10.1093/bja/aet376.
Pham HP, Shaz BH. Update on massive transfusion. Br J Anaesth. 2013 Dec;111 Suppl 1:i71–i82.
Journal cover image

Published In

Br J Anaesth

DOI

EISSN

1471-6771

Publication Date

December 2013

Volume

111 Suppl 1

Start / End Page

i71 / i82

Location

England

Related Subject Headings

  • Tranexamic Acid
  • Thrombelastography
  • Humans
  • Hemorrhage
  • Blood Transfusion
  • Blood Coagulation Factors
  • Blood Coagulation Disorders
  • Anesthesiology
  • 3202 Clinical sciences
  • 1103 Clinical Sciences