[A 'blind' transfusion policy in patients with acute severe blood loss]

Three patients presented with acute, excessive bleeding: a 54-year-old man following trauma to the pelvis, a 34-year-old woman with postpartum blood loss and a 62-year-old man with a duodenal ulcer. Treatment consisted of surgery, the administration of blood products and haemostatic agents, in varying strategies. The men recovered but the woman died as a result of cardiac rhythm disorders. It is unclear to what extent blood products should be used in patients with acute, excessive blood loss. Also, haemostatic agents have already found a place in the treatment of these patients, but it is unclear whether they should be administered early, as prophylaxis, or later when all other treatments have failed. While official registration of the haemostatic agent recombinant activated factor VII for this indication is pending, it is important that treatment with rFVIIa be embedded in a structured protocol to prevent overuse of blood products and administration of this medication to patients who do not need it. Controlled clinical trials for validation should be carried out prior to the implementation of such a protocol.