massive transfusion


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Related to massive transfusion: massive transfusion syndrome

massive transfusion

The infusion, in a 24-hour period, of a blood volume that approaches or exceeds the recipient’s calculated blood volume. Massive transfusions are administered in medical or surgical emergencies, or operations involving major blood loss (e.g., hip replacement).

Adverse effects
Dilutional/depletional coagulopathy with factor-V and -VIII deficiency and quantitative and/or qualitative platelet defects; metabolic acidosis or alkalosis, hypocalcaemia, volume overload, hypothermia (due to infusion of cool blood, uncommon in practice), arrhythmias, and inability to properly “type” red cells (as most of the circulating RBCs are of donor origin).

Management of complications
Give 4–6 units of platelets and 1–2 units of plasma for each 15 units of RBCs; monitor blood gases and adjust accordingly; IV calcium prn.

massive transfusion

Transfusion medicine The infusion, in a 24-hr period, of a blood volume that approaches or exceeds the recipient's calculated blood volume

massive transfusion

The replacement of at least half of a person's blood cells in less than a day.

CAUTION!

Common complications include the dilution of coagulation proteins and platelets (increasing the probability of bleeding); a decrease in the plasma calcium concentration (transfused blood is stored in citrate, which binds calcium); metabolic alkalosis (citrate generates bicarbonate); hypothermia (blood is stored cold and needs to be appropriately warmed before it is infused); and alterations in the serum concentration of potassium.

Patient care

To address complications of massive transfusion in the acutely bleeding patient, the patient's vital signs, complete blood count, serum chemistries, acid/base balance and PT/PTT should be monitored frequently. Coagulation factors, donated plasma, platelets, and electrolytes should be given as indicated by test results.

See also: transfusion
References in periodicals archive ?
SC2i then asked physicians from Walter Reed National Medical Center and the Uniformed Services University of the Health Sciences to assess the likelihood that wounds in those areas of the body would be severe enough to warrant the consideration of a massive transfusion. The combination of historical data and physicians' assessments enabled SC2i to further refine its model.
Complications of massive transfusion. Chest 2010; 137(1):209-20.
The majority of participants (63.3%) felt that use of TXA as part of a massive transfusion protocol would have a significant impact on the survival of those trauma patients who receive it.
Bonilla et al., "Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery," Canadian Journal of Anesthesia, vol.
Despite being aware of the value of early restrictive transfusions in this type of procedure and patient (with immature haemostatic systems, (20)) we continue to advocate the use of strategies that limit and may eventually replace this strategy (often massive transfusion), which has been correlated with multiple risks and potential complications.
To facilitate the early transfusion of plasma, 69% of sites indicated that they have plasma immediately available for massive transfusion protocols (MTP) activation.
Coagulopathy during massive transfusion is a multifactorial pathophysiological mechanism that occurs due to hemodilution, hypothermia, the use of fractionated blood products and disseminated intravascular coagulation (DIC).
Massive transfusion is the transfusion of 50% or more of the total blood volume in circulation in a period of 3 hours or less or the total blood volume or more in less than 24 hours [3].
Only two cases of GCTB have ever been reported in HIV-positive patients, and neither of these cases required a massive transfusion of blood products." [1,5]
Maternal morbidity can be monitored in 'near-miss' assessment, for which there is growing agreement of specific criteria in terms of intensive care admission, massive transfusion, need for hysterectomy, etc., since there are many disasters that can happen before the point of mortality is reached.
Most massive transfusion protocols provide for the rapid delivery of 4 to 8 units of red blood cells and a similar number of units of fresh frozen plasma to the patient's bedside.

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