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Transfusion practice in massively bleeding patients: time for a change?
P I Johansson1, M B Hansen, H Sørensen
1Department of Clinical Immunology, University Hospital of Copenhagen, Copenhagen, Denmark. p.johansson@post.tele.dk
Vox Sanguinis
|August 17, 2005
Summary
Inadequate transfusion therapy in massively bleeding patients leads to higher mortality and microvascular bleeding. Early, balanced transfusion protocols, like the acute transfusion package (ATP), are vital for improving outcomes in trauma patients.
Area of Science:
- Trauma and Emergency Medicine
- Transfusion Medicine
- Critical Care
Background:
- Fatal cases of inadequate transfusion therapy in massively bleeding patients were identified.
- Transfusion practices in acutely multitransfused patients require evaluation.
Purpose of the Study:
- To review and evaluate transfusion practices in acutely multitransfused patients.
- To assess the impact of transfusion adequacy on mortality and complications.
Main Methods:
- Retrospective review of patients receiving >10 units of red blood cells (RBC) within 24 hours.
- Analysis of 30 blood components within 7 days of admission.
- Comparison of outcomes between inadequately transfused (IT) and adequately transfused (AT) groups.
Main Results:
- Thirty-nine patients were identified; 13 were inadequately transfused (IT).
- IT patients had significantly higher mortality (12/13) compared to AT patients (13/26, P=0.013).
- IT patients experienced more microvascular bleeds (10/13 vs. 4/26, P=0.001) and lower initial platelet counts (40x10^9/l vs. 80x10^9/l, P=0.024).
Conclusions:
- Early balanced transfusion therapy is critical for massively bleeding patients.
- A proactive blood bank approach, including an acute transfusion package (ATP), is recommended.
- The ATP, comprising 5 RBC, 5 FFP, and 2 PC units, aims to ensure balanced transfusion therapy.