Massive transfusion update
Keywords:
MASSIVE TRANSFUSION, MASSIVE HEMORRHAGE, MASSIVE TRANSFUSION PROTOCOL, DAMAGE CONTROL RESUSCITATION, HEMOSTATIC RESUSCITATION, WHOLE BLOOD, BLOOD COMPONENTS, BLOOD PRODUCTS
Abstract
Massive transfusion poses clinical, organizational and logistic challenges for the health staff in general, and the Transfusion Medicine Services in particular. There is no universally accepted definition for massive transfusion, the most widely used being based on the number of blood units administered in a certain period of time. Most massive transfusion events occur in the context of severe hemorrhage on surgical or multiple-trauma patients or patients with gastrointestinal or obstetric bleeding. Today, damage control resuscitation and massive transfusion protocols are the most common strategies for initial treatment, followed by personalized therapy, goal-directed, my means of monitoring coagulation in real time with viscoelastic studies. There are disputes as to the best surgical treatment, including using whole blood, the relation of blood components to be used, the use of coagulation factor concentrates and the optimal indication of tranexamic acid. The study of ideal products to treat patients with massive hemorrhage has become an area of great interest for scientific research. The clinical context of the hemorrhagic event, the number of blood components transfused, patient's age and comorbilities are the most important predictors for survival in the short and long term. This narrative review explores the current state of affairs on knowledge about massive transfusion, as well as progress to be expected in the near future.
References
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10) Zatta AJ, McQuilten ZK, Mitra B, Roxby DJ, Sinha R, Whitehead S, et al. Massive Transfusion Registry Steering. Elucidating the clinical characteristics of patients captured using different definitions of massive transfusion. Vox Sang 2014; 107(1):60-70. doi: 10.1111/vox.12121.
11) Dzik WS, Ziman A, Cohn C, Pai M, Lozano M, Kaufman RM, et al. Survival after ultramassive transfusion: a review of 1360 cases. Transfusion 2016; 56(3):558-63. doi: 10.1111/trf.13370.
12) Thomasson RR, Yazer MH, Gorham JD, Dunbar NM. International assessment of massive transfusion protocol contents and indications for activation. Transfusion 2019; 59(5):1637-43. doi: 10.1111/trf.15149.
13) Gipson JS, Wood EM, Cole-Sinclair MF, McQuilten Z, Waters N, Woodford NW. Major haemorrhage fatalities in the Australian national coronial database. Emerg Med Australas 2018; 30(3):382-8. doi: 10.1111/1742-6723.12915.
14) Hoffman M, Monroe DM 3rd. A cell-based model of hemostasis. Thromb Haemost 2001; 85(6):958-65.
15) Ditzel RM, Anderson JL, Eisenhar WJ, Rankin CJ, DeFeo DR, Oak S, et al. A review of transfusion- and trauma-induced hypocalcemia: Is it time to change the lethal triad to the lethal diamond? J Trauma Acute Care Surg 2020; 88(3):434-9. doi: 10.1097/TA.0000000000002570.
16) Giancanrelli A, Birrer KL, Alban RF, Hobbs BP, Liu-DeRyke X. Hypocalcemia in trauma patients receiving massive transfusion. J Surg Res 2016; 202(1):182-7. doi: 10.1016/j.jss.2015.12.036.
17) MacKay EJ, Stubna MD, Holena DN, Reilly PM, Seamon MJ, Seamon MJ, et al. Abnormal calcium levels during trauma resuscitation are associated with increased mortality, increased blood product use, and greater hospital resource consumption: a pilot investigation. Anesth Analg 2017; 125(3):895-901. doi:10.1213/ANE.0000000000002312.
18) Giannoudi M, Harwood P. Damage control resuscitation: lessons learned. Eur J Trauma Emerg Surg 2016; 42(3):273-82. doi:10.1007/s00068-015-0628-3.
19) Leibner E, Andreae M, Galvagno SM, Scalea T. Damage control resuscitation. Clin Exp Emerg Med 2020; 7(1):5-13. doi: 10.15441/ceem.19.089.
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Published
2023-05-31
How to Cite
1.
Berro M. Massive transfusion update. Rev. Méd. Urug. [Internet]. 2023May31 [cited 2024Dec.18];39(2):e401. Available from: https://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/1030
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