Massive transfusion in Trauma
Definition
- 10 unit transfusion or ongoing requirement of >150 ml/hr or
- transfusion of 50% of the patients blood volume within 3 hours or
- transfusion of patients total blood volume (or 10 units) in 24 hours
Actions
- Provide adequate oxygenation
- Control source of haemorrhage first THEN restore circulating volume
- Upon gaining IV access (wide bore), send x-match, FBC, PT, APTT , fibrinogen, U&E
- Use crystalloid (NOT colloid) [EMJ Journal Review]
- Early transfusion of RBC
- Anticipate coagulopathy
- Beware hypothermia
- Lactate measurement is helpful in assessing perfusion response to therapy
- Call for help (surgical and haematologist) early
- Inform haematology lab that massive haemorrage is in progress
Points
- Call for help (surgical and haematologist) early
- Please remember that packed red cells also contain lactate, potassium and citrate.
- Target Hb > 8g/dl
- Target platelets >75 x109 (unless multi-trauma or CNS injury where target > 100 x109)
- Target fibrinogen >1.0 g/l
- Platelet count falls by 50% if blood volume is replaced
- Risk of transfusion reaction following un-crossmatched blood is 0.1% - 0.5%
- Indications for recombinant factor VIIIa include: Uncontrolled haemorrhage failing to respond to
surgical and non-surgical methods including replacement and correction off blood products
- Indications for Prothrombin Concentrate Complex (PCC - Octaplex) in trauma include haemophilia or life threatening bleed in patients on warfarin (more details)
