Massive Blood Transfusion

Question 1

Define massive blood transfusion.

Answer 1

Massive blood transfusion is replacement of patient’s total blood volume (approximately 10 units of blood) in 12 to 24 hours.

Question 2

What are the clinical features of massive blood transfusion?

Answer 2

Hypovolemic shock
Thrombocytopenia
Coagulation factor depletion
Hypocalcemia
Hyperkalemia
Acid/Base alteration
Hypothermia

Question 3

What conditions or situations are associated with massive blood transfusion?

Answer 3

1. Surgical bleeding
2. Bleeding disorders - vWD, hemophilia A/B
3. Trauma
4. DIC
5. Post-CPB coagulopathy
6. Obstetrical hemorrhage

Question 4

What is the general approach to severe bleeding requiring massive blood transfusion?

Answer 4

1. Assess need for airway management and CPR
2. If during surgery, consider risk/benefit of aborting procedure.
3. Call for help/notify blood bank
4. Add monitors and rapid transfusion devices as needed
5. Minimize hyporthermia
6. Labs
7. Check PLTs/coags/fibrinogen to assess need for component therapies
8. Replace calcium and treat hyperkalemia
9. Consider recombinant factor VIIa if persistent coagulopathy