Massive transfusion

Question 1

What is the definition of Massive Transfusion?

Answer 1

• Transfusion of >1x blood volume in 24hr, or
• Transfusion of >50% blood volume in 4hr

Blood volume = 70ml/kg in adults

Blood volume = 80ml/kg in children

(Aust Red Cross def’n)

Question 2

List 6 drawbacks of blood transfusion.

Answer 2

1. Cost
2. Volume directly correlated to moratlity
3. Volume directly correlated to morbidity
   
   1. ARDS
   2. Multi-organ failure
   3. Anaphylaxis
   4. Blood borne infection - viral and bacterial
   5. Immunosuppression
   6. GVHD

Question 3

List three indications for activation of MTP.

Answer 3

1. Requirement for 4u PRBCs in <4h + shock + predicted ongoing bleeding
2. Predicted requirement of >=4u PRBCs in <4hr + shock + predicted ongoing bleeding
3. Predicted requirement of >= 8uPRBCs in <24hr
4. Severe pelvic, thoracic, abdominal and/or multiple long bone trauma
5. Major obstetric, GI or surgical bleeding

Question 4

List the four goals of MTP.

Answer 4

1. Early recognition of massive haemorrhage
2. Definitive surgical or IR control of haemorrhage
3. Replacement of blood volume and Hb IOT maintain tissue perfusion and oxygenation
4. Replacement of specific blood components IOT avoid coagulopathy

Question 5

What is Acute Traumatic Coagulopathy?

Answer 5

ATC is a group of poorly understood coagulation disorders caused acutely by the combination of shock and significant tissue injury.

Trauma patients presenting with ATC have been shown to be 4x more likley to die than those who do not.

Question 6

What biochemical goals should be aimed for during MTP administration?

Answer 6

• pH > 7.2
• BE < -6
• Lactate < 4
• Ca > 1.1
• PLTs > 50
• Fibrinogen > 1
• PT/APTT < 1.5 x normal
• INR < 1.5

Also maintain T > 35degs