Blood transfusion rates in the are of acute trauma
University of Maryland, Baltimore, Baltimore, Maryland, United States Transfusion
(Impact Factor: 3.23).
07/2004; 44(6):809-13. DOI: 10.1111/j.1537-2995.2004.03409.x
Ten to 15 percent of all RBCs are used in the care of injury. Understanding patterns of RBC use is important. Routine resource allocation, planning for mass casualty situations, designing research, and optimizing triage all can be usefully informed.
Blood Bank and Trauma Registry records were linked to produce a transfused blood product list for each patient directly admitted from the scene of injury to a large Level 1 trauma center in calendar year 2000. Categorical associations between demographic data, Injury Severity Score, transfused products, and outcome were sought. Special attention was paid to the groups receiving uncross-matched RBCs and more than 10 units of RBCs.
Eight percent (479/5645) of acute trauma patients received RBCs, using 5219 units and sustaining an overall mortality of 27 percent. Sixty-two percent of RBCs were given in the first 24 hours of care. Three percent of patients (147 injured) received more than 10 units and received 71 percent of all RBCs given. Mortality in this cohort was 39 percent. Ninety percent of the patients who received more than 10 units of RBCs received plasma, and 71 percent received PLTs.
A small number of patients receives most of the blood products used in the treatment of injury. Transfusion of more than 10 units of RBCs identifies a subgroup where most patients received plasma and PLTs to treat actual or anticipated dilutional coagulopathy. There is no clear threshold beyond which blood use is futile.
Available from: Binbin Zhu
- "One of lifesaving treatments of hemorrhagic shock is massive transfusion (MT). MT is commonly defined as the transfusion of at least 10 units PRBCs within 24 h to an individual patient or the transfusion of more than one blood volume in 24 h (note that adult blood volume is approximate 70 ml/kg)   . However, it is a non-physiologic state and can be associated with many complications, such as acidosis, hypothermia, coagulopathy, electrolyte abnormalities, citrate toxicity, and transfusionrelated acute lung injury (TRALI). "
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ABSTRACT: Bleeding is a common problem during resection of a retroperitoneal mass. Massive bleeding may occur in case of injury of an adjacent major vessel or organ. This case report describes a successful anesthetic management of a patient with 10 l of blood loss within three hours surgery. A 44-year-old woman who underwent an operation for resection of a retroperitoneal mass, went to a hypovolemic shock, due to acute life-threatening intra-operative bleeding, and was successfully rescued with a combination of measures, including control of surgical bleeding, supportive treatment with rapid fluid infusion, massive transfusion of blood products and administration of intravenous vasoactive agents for maintaining tissue perfusion and oxygenation, utilizing intraoperative autologous blood salvaged via cell saver, as well as prevention and treatment of complications. The patient received a total of 22 units of Packet Red Blood Cells (PRBCs), 18 units of Fresh Frozen Plasma (FFP), 10 units of cryoprecipitate, 3750 ml of her own salvage blood. Postoperatively, she was transferred to the intensive care unit (ICU) with mechanical ventilator support, where she received another 5.4 units of FFP, 10 units of cryoprecipitate. The patient developed features of early acute lung injury such as fever and hypoxemia, and was managed successfully with mechanical ventilator support for a few days. At a three-month follow-up, the patient was doing very well. This paper explores the pathogenesia, implications, prevention and treatment of the transfusion-associated complications such as acidosis, hypothermia, electrolyte abnormalities, and transfusion-related acute lung injury (TRALI). Particular attention is given to the prevention of secondary coagulopathy of the patient requiring massive blood transfusion. This case study presents a good reference for similar anesthetic scenario in the future.
Available from: Michael H Livingston
- "These rates are similar to those reported for adults. In a cohort of 5645 adult patients from an American trauma hospital, 3% received more than 10 units of pRBC during their hospital admission . Similarly, a massive transfusion rate of 8% was observed in a study of 7418 adult patients from the German Trauma Registry . "
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The purpose of this study was to quantify the incidence, patient profile, and outcomes associated with massive transfusion in paediatric trauma patients prior to establishing a massive transfusion protocol.
We performed a retrospective review of paediatric trauma patients treated at London Heath Sciences Centre between January 1, 2006 and December 31, 2011. Inclusion criteria were Injury Severity Score (ISS) greater than 12 and age less than 18 years.
435 patients met the inclusion criteria. 356 (82%) did not receive packed red blood cells in the first 24 hours, 66 (15%) received a non-massive transfusion (<40 mL/kg), and 13 (3%) received a massive transfusion (>40 mL/kg). Coagulopathy of any kind was more common in massive transfusion (11/13; 85%) than non-massive (32/66; 49%) (p = 0.037). Hyperkalemia (18% versus 23%; p = 0.98) and hypocalcemia (41% versus 46%; p = 1.00) were similar in both groups. Of the 13 massively transfused patients, 9 had multisystem injuries due to a motor vehicle collision, 3 had non-accidental head injuries requiring surgical evacuation, and 1 had multiple stab wounds. In the absence of a massive transfusion protocol, only 8 of the 13 patients received both fresh frozen plasma and platelets in the first 24 hours. Massive transfusion occurred in patients from across the age spectrum and was associated with severe injuries (mean ISS = 33), a higher incidence of severe head injuries (92%), longer hospital stay (mean = 36 days), and increased mortality (38%).
This study is the first to describe the incidence, complications, and outcomes associated with massive transfusion in paediatric trauma patients prior to a massive transfusion protocol. Massive transfusion occurred in 3% of patients and was associated with coagulopathy and poor outcomes. Protocols are needed to ensure that resuscitation occurs in a coordinated fashion and that patients are given appropriate amounts of fresh frozen plasma, platelets, and cryoprecipitate.
Available from: Timothy E Miller
- "It is important to note that only 25% of trauma patients actually receive a blood transfusion, with just 2 to 3% of civilian traumas and 7 to 8% of military trauma patients receiving a massive transfusion (MT) . The definition of a MT varies within the literature. "
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ABSTRACT: Traumatic injury is a common problem, with over five million worldwide deaths from trauma per year. An estimated 10 to 20% of these deaths are potentially preventable with better control of bleeding. Damage control resuscitation involves early delivery of plasma and platelets as a primary resuscitation approach to minimize trauma-induced coagulopathy. Plasma, red blood cell and platelet ratios of 1:1:1 appear to be the best substitution for fresh whole blood; however, the current literature consists only of survivor bias-prone observational studies.
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