Lecture 12: Major Haemorrhage

Question 1

What are the criteria for major haemorrhage?

Answer 1

Loss of >1 blood volume in 24h or >50% in <3h or bleeding >150 mL/min.

Question 2

Name 4 clinical signs of hypovolaemic shock.

Answer 2

Tachycardia, cold/clammy skin, confusion, decreased urine output.

Question 3

What is the first action when triggering MTP?

Answer 3

Call lab to activate protocol; assign a “runner” for sample transport.

Question 4

When is O RhD-negative blood used?

Answer 4

For unknown patient blood group or critical bleeding (issued in 5 mins).

Question 5

What is the 4:4:1 ratio in Pack A?

Answer 5

4 RBCs : 4 FFP : 1 platelet unit.

Question 6

List target ranges for Hb, platelets, and fibrinogen during MTP.

Answer 6

Hb: 80–100 g/L

Platelets: >75 ×10⁹/L

Fibrinogen: >1.5 g/L.

Question 7

When is cryoprecipitate given in MTP?

Answer 7

For fibrinogen <1.5 g/L or DIC (contains fibrinogen, vWF, Factor VIII).

Question 8

How does tranexamic acid work in major haemorrhage?

Answer 8

Inhibits fibrinolysis; give 1g IV stat, then 1g over 8h.

Question 9

Name 3 risks of massive transfusion.

Answer 9

DIC, hypocalcaemia (citrate toxicity), hyperkalaemia.

Question 10

What post-transfusion tests are critical for audit?

Answer 10

FBC, coagulation screen, fibrinogen, ionized calcium, traceability.