Massive Transfusion Flashcards
What defines a massive transfusion?
Replacement of one or more blood volumes (≈5000 mL or 10 units in a 70 kg adult) within 24 hours.
What physiological systems respond to hemorrhage?
Nervous, hormonal, and circulatory systems.
What blood loss percentage can lead to hemorrhagic shock?
Acute loss >30% of total blood volume.
Name 4 complications of massive transfusion.
Hypothermia (rapid infusion of cold blood → ↓platelet function, coagulopathy).
Citrate toxicity (hypocalcemia → tingling, tetany).
Hyperkalemia (K⁺ leakage from stored RBCs).
Dilutional coagulopathy (↓platelets/clotting factors).
How does hypothermia affect bleeding?
Every 1°C drop ↑ blood loss by 22%.
What is TACO?
Transfusion-Associated Circulatory Overload (excess volume → pulmonary edema).
What is the 1:1:1 ratio used for?
Resuscitation with RBC:Plasma:Platelets to prevent coagulopathy and TACO
How does Tranexamic Acid (TXA) work?
Antifibrinolytic – stabilizes clots by inhibiting plasminogen → ↓bleeding/mortality.
When is FVIIa controversial?
May ↓RBC use but ↑ thromboembolic risk.
What replaces citrate toxicity?
Calcium supplementation.
Why was “MTP” renamed to “MHP”?
Focus on hemorrhage (cause) rather than transfusion (effect).
What are key lab tests during MHP?
CBC, INR/PTT, fibrinogen, electrolytes, Ca²⁺, lactate.
What is the 7 Ts framework?
Triggering, Team, Testing, TXA, Temperature, Transfusion, Termination.
What is the goal of standardized MHP?
Reduce variability in activation, compliance, and outcomes.
How to manage hypothermia in MHP?
Use blood warmers, monitor core temp (goal ≥36°C).
How do we manage Citrate Toxicity in an MHP?
Slower infusion and calcium replacement if severe
How do we manage Hyperkalemia in an MHP?
Need to monitor hematologic, renal, electrolyte, and infusion rates
During an MHP, what is given to prevent hypovolemia and what is the risk of giving it?
Colloids and/or crystalloids (i.e., Albumin) are given to maintain circulatory flow and decrease shock, but if PT/PTT baseline values are abnormal, giving more solutions can further dilute coagulation factors
Fill in the numbers: Dilutional coagulopathy: % of massively transfused patients develop an INR >, and % have thrombocytopenia with a platelet count of <
50
2.0
33
50
How do we manage Dilutional coagulopathy in an MHP?
Transfuse platelets
Transfuse frozen plasma to try to control deficiencies
How do we manage uncontrolled bleeding in an MHP?
Can given hemostatic agents such as Desmopressin, recombinant factor VIIa and antifibrinolytics (tranexamic acid) to control bleeding
Who is at risk for TACO?
Elderly, children, and patients with impaired cardiac, renal, and pulmonary functions
When is TXA most beneficial and least beneficial in an MHP?
Most beneficial when given immediately
No benefit after 3 hours from injury/onset of bleeding
What is Prothrombin Complex Concentrate (Octaplex) used to treat?
Underlying coagulopathies the patient may have
