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Transfusion practices in trauma.

Ramakrishnan VT, Cattamanchi S - Indian J Anaesth (2014)

Bottom Line: Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy.Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids.Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Sri Ramachandra Medical College Research Institute, Porur, Chennai, Tamil Nadu, India.

ABSTRACT
Resuscitation of a severely traumatised patient with the administration of crystalloids, or colloids along with blood products is a common transfusion practice in trauma patients. The determination of this review article is to update on current transfusion practices in trauma. A search of PubMed, Google Scholar, and bibliographies of published studies were conducted using a combination of key-words. Recent articles addressing the transfusion practises in trauma from 2000 to 2014 were identified and reviewed. Trauma induced consumption and dilution of clotting factors, acidosis and hypothermia in a severely injured patient commonly causes trauma-induced coagulopathy. Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy. Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids. Hence, the predominant focus is on damage control resuscitation, which is a combination of permissive hypotension, haemorrhage control and haemostatic resuscitation. Massive transfusion protocols improve survival in severely injured patients. Early recognition that the patient will need massive blood transfusion will limit the use of crystalloids. Initially during resuscitation, fresh frozen plasma, packed red blood cells (PRBCs) and platelets should be transfused in the ratio of 1:1:1 in severely injured patients. Fresh whole blood can be an alternative in patients who need a transfusion of 1:1:1 thawed plasma, PRBCs and platelets. Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury.

No MeSH data available.


Related in: MedlinePlus

Massive Transfusion Protocol (Figure 1. Stanford Massive Transfusion Protocol.[35] Reprinted from the Journal of the American College of Surgeons, 209 (2), Daniel J. Riskin, Thomas C. Tsai, Loren Riskin, et al., Massive Transfusion Protocols: The Role of Aggressive Resuscitation Versus Product Ratio in Mortality Reduction, 198-205, Copyright (2009), with permission from Elsevier). ABG – Arterial blood gases; CBC – Complete blood count; DIC – Disseminated intravascular coagulation; FFP – Fresh frozen plasma; INR – Internationalized normalized ration; MTP – Massive transfution protocol; PRBCs – Packed red blood cells; PT – Prothrombin time; PTT – Partial thromboplastin time; PLT – Platelets and rFVIIa – recombinant factor VII a
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Figure 1: Massive Transfusion Protocol (Figure 1. Stanford Massive Transfusion Protocol.[35] Reprinted from the Journal of the American College of Surgeons, 209 (2), Daniel J. Riskin, Thomas C. Tsai, Loren Riskin, et al., Massive Transfusion Protocols: The Role of Aggressive Resuscitation Versus Product Ratio in Mortality Reduction, 198-205, Copyright (2009), with permission from Elsevier). ABG – Arterial blood gases; CBC – Complete blood count; DIC – Disseminated intravascular coagulation; FFP – Fresh frozen plasma; INR – Internationalized normalized ration; MTP – Massive transfution protocol; PRBCs – Packed red blood cells; PT – Prothrombin time; PTT – Partial thromboplastin time; PLT – Platelets and rFVIIa – recombinant factor VII a

Mentions: Riskin et al. observed that with the implementation of MTP, deaths from trauma have decreased significantly.[35] Expeditious availability of blood products due to MTP, lead to early transfusion of PRBCs, which decreased the time for first plasma and platelet transfusion, and increased survival of trauma patients [Figure 1].[35] Enhanced communication and organisation within MTP, empowering prompt delivery of blood packs from the blood bank was fundamental to the success of the protocol.[11] Upon arrival to the ED, an MTP should enable emergency physician or trauma surgeon immediately to administer 1:1:1:1 ratio of PRBCs, plasma, platelets and cryoprecipitates, instead of administering PRBCs first and at a later stage giving plasma.[11] This means that in the ED, thawed plasma has to be readily available for administration in the first round of the MTP.[36]


Transfusion practices in trauma.

Ramakrishnan VT, Cattamanchi S - Indian J Anaesth (2014)

Massive Transfusion Protocol (Figure 1. Stanford Massive Transfusion Protocol.[35] Reprinted from the Journal of the American College of Surgeons, 209 (2), Daniel J. Riskin, Thomas C. Tsai, Loren Riskin, et al., Massive Transfusion Protocols: The Role of Aggressive Resuscitation Versus Product Ratio in Mortality Reduction, 198-205, Copyright (2009), with permission from Elsevier). ABG – Arterial blood gases; CBC – Complete blood count; DIC – Disseminated intravascular coagulation; FFP – Fresh frozen plasma; INR – Internationalized normalized ration; MTP – Massive transfution protocol; PRBCs – Packed red blood cells; PT – Prothrombin time; PTT – Partial thromboplastin time; PLT – Platelets and rFVIIa – recombinant factor VII a
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4260308&req=5

Figure 1: Massive Transfusion Protocol (Figure 1. Stanford Massive Transfusion Protocol.[35] Reprinted from the Journal of the American College of Surgeons, 209 (2), Daniel J. Riskin, Thomas C. Tsai, Loren Riskin, et al., Massive Transfusion Protocols: The Role of Aggressive Resuscitation Versus Product Ratio in Mortality Reduction, 198-205, Copyright (2009), with permission from Elsevier). ABG – Arterial blood gases; CBC – Complete blood count; DIC – Disseminated intravascular coagulation; FFP – Fresh frozen plasma; INR – Internationalized normalized ration; MTP – Massive transfution protocol; PRBCs – Packed red blood cells; PT – Prothrombin time; PTT – Partial thromboplastin time; PLT – Platelets and rFVIIa – recombinant factor VII a
Mentions: Riskin et al. observed that with the implementation of MTP, deaths from trauma have decreased significantly.[35] Expeditious availability of blood products due to MTP, lead to early transfusion of PRBCs, which decreased the time for first plasma and platelet transfusion, and increased survival of trauma patients [Figure 1].[35] Enhanced communication and organisation within MTP, empowering prompt delivery of blood packs from the blood bank was fundamental to the success of the protocol.[11] Upon arrival to the ED, an MTP should enable emergency physician or trauma surgeon immediately to administer 1:1:1:1 ratio of PRBCs, plasma, platelets and cryoprecipitates, instead of administering PRBCs first and at a later stage giving plasma.[11] This means that in the ED, thawed plasma has to be readily available for administration in the first round of the MTP.[36]

Bottom Line: Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy.Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids.Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Sri Ramachandra Medical College Research Institute, Porur, Chennai, Tamil Nadu, India.

ABSTRACT
Resuscitation of a severely traumatised patient with the administration of crystalloids, or colloids along with blood products is a common transfusion practice in trauma patients. The determination of this review article is to update on current transfusion practices in trauma. A search of PubMed, Google Scholar, and bibliographies of published studies were conducted using a combination of key-words. Recent articles addressing the transfusion practises in trauma from 2000 to 2014 were identified and reviewed. Trauma induced consumption and dilution of clotting factors, acidosis and hypothermia in a severely injured patient commonly causes trauma-induced coagulopathy. Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy. Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids. Hence, the predominant focus is on damage control resuscitation, which is a combination of permissive hypotension, haemorrhage control and haemostatic resuscitation. Massive transfusion protocols improve survival in severely injured patients. Early recognition that the patient will need massive blood transfusion will limit the use of crystalloids. Initially during resuscitation, fresh frozen plasma, packed red blood cells (PRBCs) and platelets should be transfused in the ratio of 1:1:1 in severely injured patients. Fresh whole blood can be an alternative in patients who need a transfusion of 1:1:1 thawed plasma, PRBCs and platelets. Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury.

No MeSH data available.


Related in: MedlinePlus