6.1 Major Haemorrhage Flashcards
Q1 — Major haemorrhage
A 45-year-old man has a major haemorrhage following significant trauma and is admitted to the emergency department. He does not have a head injury.
a) Give any two definitions of a major haemorrhage.
● Loss of more than one blood volume within 24 hours (approximately 70ml/kg).
● 50% of total blood volume lost in less than 3 hours.
● Bleeding in excess of 150ml/minute.
● Bleeding leading to a systolic blood pressure
of <90mmHg and a pulse of >110 bpm.
b) What are the principles of management of a major
haemorrhage in this patient?
● Ensure that the appropriate team members are contacted (activate the trauma team).
● Activation of the major haemorrhage protocol.
● Identification of the source of bleeding.
● Control/prevention of further blood loss.
● High-flow oxygen/airway control.
● Establish IV or IO access.
● Baseline bloods.
● Frequent measurement of Hb and
coagulation using point-of-care tests
(such as TEG®/ROTEM®/HemoCue®/ABG to guide transfusion).
● Frequent measurement and
correction of electrolyte abnormalities.
● Transfusion of blood and coagulation
products to restore organ perfusion.
● Measures to maintain/achieve normothermia.
● Consider imaging and/or damage control surgery.
● Consider the use of antifibrinolytics (e.g. tranexamic acid).
c) List any three metabolic complications that might follow a
massive blood transfusion.
● Hypothermia.
● Acid base abnormalities
(metabolic alkalosis, acidosis).
● Electrolyte abnormalities —
hypocalcaemia, hyperkalaemia/
hypokalaemia, hypomagnesaemia.
● Citrate toxicity.
d) What are the immunologic complications that can occur after a massive blood transfusion?
● Transfusion-related lung injury (TRALI).
● Transfusion-associated immunomodulation (TRIM).
● Transfusion related graft-vs-host disease.
e) What are the other complications that might follow a massive
blood transfusion?
Transfusion reactions:
● Immediate haemolytic transfusion reactions
and non-haemolytic febrile reactions.
● Allergic reactions.
Others:
● Coagulopathy.
● Transfusion-related infections.
● Transfusion-associated circulatory overload (TACO)
