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 ?
The evaluation of postpartum bleeding includes clinical, haemodynamic and laboratory variables used to classify the severity (3) and assess patients that benefit from early massive transfusions (4) and admission to the intensive care unit, and women at risk of developing complications due to severe haemorrhagic shock.
Hyperkalemic death during use of a high-capacity fluid warmer for massive transfusion.
The civilian study found 30-day survival was 60% in patients who received more than 1 U of plasma or platelets with every 2 U of RBCs, compared with 40% survival with lower ratios of plasma or platelets to RBCs, so the investigators recommended a 1:1:1 ratio of plasma, platelets, and RBCs in massive transfusions.
As mentioned, the second major aspect of damage control resuscitation recommends a judicious use of blood products in more favorable ratios to improve outcome in the severely injured, particularly in patients requiring a massive transfusion.
The initial two patients were each taken back to theatre twice, over a period of over 24 hours, during which they received massive transfusions.
Massive transfusion strategy or massive confusion in trauma with massive and ongoing bleeding.
Compared with subjects given placebo injection, those who received rF-VIIa had fewer transfusions and lower rates of massive transfusion (>12 units), acute respiratory distress syndrome, and multiorgan failure.
The development and implementation of massive transfusion protocols have been associated with a reduction in mortality and overall blood product use in trauma centre.
Competency assessment for a Massive Transfusion Protocol: managing cross-training demands," pages 14-16, offers one institution's experience as a model for ensuring that the best possible procedures are in place for emergent events in the trauma setting and otherwise.
5] Massive transfusion is also commonly done in the Emergency department in road traffic accidents and is associated with complications like hypothermia and hypocalcaemia.
Plasma transfused as part of trauma resuscitation, massive transfusion protocol, or "keep ahead" orders (orders placed for the possibility of ongoing transfusion needs) were excluded from the study.

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