Massive Transfusion and Massive Transfusion Protocols. Where We Are and Where We Need to Go.Raul Coimbra
Editorials, no. 5, 2017
Article DOI: 10.21614/chirurgia.112.5.512
Bleeding is the most frequent cause of death following injury. Bleeding may be external, internal, acute, indolent, controllable, massive, organ-specific or diffuse due to coagulopathy, hypothermia and acidosis, the lethal triad. The definition of Massive Transfusion, although intuitive and related to massive or significant continued hemorrhage, has varied in several studies, creating confusion and difficulties for data comparison between studies and scientific interpretation. The most commonly accepted definition of massive transfusion is that of greater than 10 units of packed red blood cells (PRNCÃ¢Â€Â™s) transfused in a 24 h period. Although not ideal, this definition is easy to apply and allows some uniformity if applied consistently across the board. It turns out that only 3%-8% of all injured patients admitted to trauma centers will require massive transfusion and 24% of those presenting in shock will be massively transfused. It becomes apparent that being prepared with process in place to quickly and effectively make blood available to injured patients is of utmost importance. The real issue is how to identify early on those patients who will go on to require blood transfusion. Classic factors related to massive blood loss include, but are not limited to multicavitary or transpelvic trauma, large hemoperitoneum identified by FAST, patients admitted with hypotension (Systolic Blood pressure 90 mmHg) and tachycardia (Heart Rate 120), Significant base deficit in the trauma bay or emergency department, and those presenting with elevated INR due to injury severity or use of anticoagulants such as Coumadin and other new anticoagulants.