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Indications for plasma in massive transfusion.

Peter Hellstern1, Hannelore Haubelt

  • 1Institute of Hemostaseology and Transfusion Medicine, City Hospital, Bremserstrasse 79, D-67063, Ludwigshafen am Rhein, Germany. peterhellstern@medicusnet.de

Thrombosis Research
|October 16, 2002
PubMed
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Massive transfusion protocols aim to restore volume and oxygen delivery but can cause coagulopathy. Timely plasma and platelet transfusion is crucial to correct bleeding disorders and improve patient outcomes.

Area of Science:

  • Trauma and Emergency Medicine
  • Hematology
  • Transfusion Medicine

Background:

  • Massive transfusion (MT) initially focuses on volume and oxygen delivery using crystalloids, colloids, and red blood cells.
  • This approach can lead to dilution coagulopathy, exacerbated by hypothermia, acidosis, and disseminated intravascular coagulation (DIC).
  • Hemostatic disorders significantly worsen prognosis in massively transfused patients.

Purpose of the Study:

  • To highlight the critical second objective in MT: halting microvascular bleeding (MVB) caused by impaired hemostasis.
  • To emphasize the importance of prompt plasma and platelet concentrate administration.
  • To outline laboratory monitoring parameters and transfusion triggers for coagulopathy.

Main Methods:

  • Monitoring key laboratory values: platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen.

Related Experiment Videos

  • Identifying coagulopathy when PT or APTT exceed 1.5 times controls or fibrinogen falls below 1.0 g/l.
  • Administering 10-15 ml/kg plasma repeatedly to raise clotting factor levels and achieve hemostasis.

    • Main Results:

    • Dilution coagulopathy is a common complication of initial MT strategies.
    • Impaired hemostasis leads to microvascular bleeding and poorer patient prognosis.
    • Laboratory monitoring and timely intervention with plasma and platelets are essential for managing coagulopathy.

    Conclusions:

    • The second therapeutic goal in MT is to correct hemostatic disorders and stop microvascular bleeding.
    • Close laboratory monitoring is vital for guiding transfusion therapy.
    • Efficient laboratory turnaround times and plasma availability are critical for successful management of massive blood loss.