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massive transfusionThe 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).
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 transfusionTransfusion medicine The infusion, in a 24-hr period, of a blood volume that approaches or exceeds the recipient's calculated blood volume
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.
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.