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Massive transfusion and coagulopathy: pathophysiology and implications for clinical management
Jean-François Hardy1, Philippe De Moerloose, Marc Samama
1Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, Québec, Canada. jean-francois.hardy@umontreal.ca
Summary
Massive transfusion can cause coagulopathy due to dilution, hypothermia, and other factors. Maintaining normal temperature and adequate red blood cells is key to improving hemostasis during massive transfusion.
Area of Science:
- Hematology
- Critical Care Medicine
- Surgical Hemostasis
Background:
- Coagulopathy is a significant complication in patients undergoing massive transfusion.
- Understanding the multifactorial nature of coagulopathy is crucial for effective management.
Purpose of the Study:
- To review the pathophysiology of coagulopathy in massively transfused patients.
- To recommend optimal treatment strategies for surgical and trauma settings.
Main Methods:
- Systematic literature search of Medline using keywords: "massive transfusion," "transfusion," "trauma," "surgery," "coagulopathy," "hemostatic defects."
- Expert review of identified articles.
Main Results:
- Coagulopathy arises from hemodilution, hypothermia, fractionated blood products, and disseminated intravascular coagulation.
- Maintaining normothermia and adequate hematocrit (>30%) are vital for hemostasis.
- Platelets and fresh frozen plasma use should be guided by clinical judgment and testing.
Conclusions:
- Massive transfusion-associated coagulopathy is a complex clinical issue.
- Effective treatment involves maintaining tissue perfusion, correcting hypothermia and anemia, and using blood products judiciously.