EMed

Massive transfusion in Trauma

Definition

  • 10 unit transfusion or ongoing requirement of >150 ml/hr or
  • Transfusion of 50% of the patients blood volume within 3 hours or
  • Transfusion of patients total blood volume (or 10 units) in 24 hours

Actions

  • Call for help early
  • Provide adequate oxygenation
  • Control source of haemorrhage first then restore circulating volume
  • Upon gaining IV access (wide bore), send x-match, FBC, PT, APTT , fibrinogen, U&E
  • Use crystalloid (NOT colloid) [EMJ Journal Review]
  • Early transfusion of RBC
  • Anticipate coagulopathy
  • Consider activating Massive Transfusion Protocol
  • Beware hypothermia
  • Monitor lactate (measure response to therapy)
  • Beware hypocalcaemia

Points

  • Call for help (surgical and haematologist) early
  • Please remember that packed red cells also contain lactate, potassium and citrate
  • More on Massive Transfusion Protocol
  • Target Hb > 8g/dl
  • Target platelets >75 x109 (unless multi-trauma or CNS injury where target > 100 x109)
  • Target fibrinogen >1.5 g/l (>2.0 in Obstetric patients with ongoing haemorrhage)
  • Platelet count falls by 50% if blood volume is replaced
  • Risk of transfusion reaction following un-crossmatched blood is 0.1% - 0.5%
  • Indications for recombinant factor VIIa (discuss with haematology) include: Uncontrolled haemorrhage failing to respond to surgical and non-surgical methods including replacement and correction off blood products
  • Indications for Prothrombin Concentrate Complex (PCC - Octaplex) in trauma include haemophilia or life threatening bleed in patients on warfarin (more details)
  • CUH PCC/Octaplex PCG 2022
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Content by Dr Íomhar O' Sullivan. Last review Greg O'Connor [Haemovigilance Officer, CUH], Dr ÍOS 25/11/11 27/04/23.