177 - Massive transfusion

Question 1

What is acute traumatic coagulopathy (ATC) ?

Answer 1

Can occur as quickly as within 30 minutes post trauma
anticoagulation and hyperfibrinolysis
In human trauma patients: associated with a 4 times higher risk of multiple organ dysfunction syndrome (MODS) and death

Question 2

When is cryoprecipitate indicated?

Answer 2

Cryoprecipitate or fibrinogen concentrate is indicated when fibrinogen levels are below 100 mg/dL [17,25,27]. The fibrinogen goal is 150–200 mg/dL with the ideal range being >200 mg/dL

Question 3

Complications ?

Answer 3

• Hypomagnesemia, hypocalcemia : secondary to citrate binding
• Hyperkalemia: secondary to increased potassium levels in the pRBC supernatant (RBC lysis) - K+ levels increase with each day of storage; >42 days, up to 45–77 mEq/L
• Hypothermia
• Metabolic alkalosis (citrate metabolized to bicqrb) AND acidosis (if low pH in pRBC unit secondary to increase lactate/pyruvate)
• Transfusion reaction : MOF, TRALI, TACO

Question 4

Whats the definition of massive transfusion (what amount of blood is needed)

Answer 4

• 1 x blood volume in 24h
• 50% over 3 hrs
• 150% over any time
• 1.5ml/kg/min any blood product over 20min

Question 5

Does a high or low shock index increase the risk of massive transfusion?

Answer 5

Higer SI, over 0.9

Question 6

How does hypocoagulability contribute to acute traumatic coagulopathy (ATC)

Answer 6

It decrease platelet aggregation, inhibiting coagulation factors, reduce synthesis, and cause fibrinolysis

Question 7

You massive transfuse a patient and on the ECG you notice a sinoventricular rhythm. What electrolyte abnormality do you expect this patient to have from the massive transfusion?

Answer 7

HyperK

Question 8

What is a reason that a patient can develop metabolic alkalemia after a massive transfusion?

Answer 8

The citrate in the blood gets metabolized to bicarbonate which increase the pH.