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| Massive transfusion in multi-trauma patients | ||||||
| Karlijn JP Van Wessem1, Bas A Twigt1, Kaj ten Duis2, Luke PH Leenen2 | ||||||
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1MD, PhD, Department of Trauma Surgery, University Medical Center Utrecht, Utrecht. The Netherlands.
2MD, Department of Trauma Surgery, University Medical Center Utrecht, The Netherlands. | ||||||
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| How to cite this article |
| Van Wessem KJP, Twigt BA, Duis ten K, Leenen LPH. Massive transfusion in multi-trauma patients. Int J Case Rep Images 2014;5(7):474–481. |
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Abstract
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Introduction:
Trauma is not only the leading cause of death in patients under 45 years of age, but also the most common cause for massive transfusion. Adequate recognition of the need for massive transfusion is paramount to decrease early mortality. Massive transfusion protocols have been developed to simplify and standardize transfusion administration are based on prevention of coagulopathy, acidosis and hypothermia. Transfusion not only refers to administering packed red blood cells (PRBC), but also limiting coagulopathy by means of using essential hemostatic blood products, such as fresh frozen plasma (FFP) and platelets (PLT).
Case Series: In this article, current opinions on massive transfusion will be discussed, based on three patients who received massive transfusion after major injury. All of the three described patients in this article developed coagulopathy, acidosis and hypothermia. Their physiology was corrected by a combination of damage control surgery and early hemostatic blood transfusion. The two surviving patients did not develop any septic complications caused by massive transfusion. At our institution, a 1:1:1 ratio of PRBC:FFP:PLT is advocated, in concordance with most current literature. Massive transfusion, however, can lead to complications such as transfusion induced lung injury, acute respiratory distress syndrome and multiple organ dysfunction syndrome. Conclusion: In this article, current literature is reviewed, and new insights regarding coagulation measurements and hemostatic products including the influence of transfusion on the immune system have been discussed. | |
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Keywords:
Multi-trauma, Coagulopathy, Acidosis, Hypothermia, Massive transfusion
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Author Contributions:
Karlijn JP Van Wessem – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Bas A Twigt – Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Kaj ten Duis – Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Luke PH Leenen – Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2014 Karlijn JP Van Wessem et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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