Massive haemorrhage

Question 1

What are the theoretical definitions of massive haemorrhage?

Answer 1

• One blood volume in 24 hours
• 50% blood volume in 3 hours
• Blood loss of 150mL/minute

Question 2

What is the obstetrics theoretical definition of minor massive haemorrhage?

Answer 2

500-1000ml blood loss

Question 3

What is the obstetrics theoretical definition of major massive haemorrhage?

Answer 3

> 1000ml blood loss

Question 4

What is the clinical definition of massive haemorrhage?

Answer 4

• Bleeding which leads to a heart rate of >110 bpm and/or systolic BP less than 90mmHg
• Bleeding which has already prompted use of emergency O- red cells

Question 5

What is the supportive management option for massive haemorrhage?

Answer 5

Blood component support

Question 6

What is the definitive management option in massive haemorrhage?

Answer 6

Stop the bleeding

Question 7

What is tranexamic acid?

Answer 7

This is an anti-fibrinolytic drug used to prevent massive bleeding, especially in post-partum haemorrhage

Question 8

What is the advantage of having a massive haemorrhage protocol?

Answer 8

A massive haemorrhage protocol facilitates prompt transfusion of appropriate blood components and streamlines communication between the blood bank and clinical area, allowing a standard approach to initial management

Question 9

What would a basic massive haemorrhage protocol look like?

Answer 9

• Call blood bank and state major haemorrhage
  
  • Send urgent blood samples
  • Resuscitate patient using ABCDE, give IV fluid and IV blood access
  • Blood bank will issue 4 units red cells, 4 units FFP and 1 unit platelets
    
    • If ongoing bleeding after initial transfusion, repeat blood samples and transfuse further RBC and FFP at a ratio of 2:1 (1:1 in trauma) (More specific after blood sampels)
    • When blood results are available, maintain Hb >80, platelets > 50x10^9,

Question 10

What is the function of red cell transfusion in massive haemorrhage?

Answer 10

Maintains tissue oxygenation

Question 11

What is the function of fresh frozen plasma and platelets in massive haemorrhage?

Answer 11

Replaces coagulation factors to help maintain coagulation close to normal

Question 12

What is the function of cryoprecipitate transfusion in massive haemorrhage?

Answer 12

Replaces fibrinogen

Question 13

What ratio of RBCs to FFP should be used in massive haemorrhage?

Answer 13

2R:1FFP in first instance
1:1 in trauma

Question 14

How can massive haemorrhage effect further bleeding risk?

Answer 14

It will increase bleeding risk due to the depletion of coagulation factors

Question 15

What specific bleeding treatment would be given to a patient with a variceal bleed of the oesophagus?

Answer 15

• Terlipressin
• Urgent endoscopy with possible EVL (Endoscopic variceal ligation)
• Antibiotics to prevent gut bacteria moving into blood