Massive Transfusion

This chapter discusses massive transfusion which is commonly defined as transfusion of 10 or more red blood cell (RBC) products within 24 hours, which approximates the total blood volume of an adult recipient. Massive transfusion can occur in a variety of clinical settings, including cardiovascular, spinal and liver surgery, trauma, gastrointestinal bleeding and obstetrics. The physiologic response to blood loss is to preferentially maintain tissue oxygenation to the brain and heart by shunting blood from other organs, shifting fluid from intracellular to extracellular space and conserving water and electrolytes. In severely injured trauma patients, uncontrolled hemorrhage with more than 50% blood loss is one of the most common causes of mortality. Severe hemorrhage accompanying obstetric complications can lead to hysterectomy and loss of future reproductive capacity or loss of the mother, child or both. When blood loss is excessive and there is shortage of time for pretransfusion testing, group O RBC and AB plasma products should be issued until the recipient's blood type is established. © 2009 Elsevier Inc. All rights reserved.

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Author Beth H. Shaz Pathology