The coagulopathy of massive transfusion

Area of Science:

• Anesthesiology
• Hematology
• Critical Care Medicine

Background:

• Massive transfusion can lead to coagulopathy in adult patients with prior normal hemostasis.
• Coagulopathy onset and severity vary significantly between trauma and elective surgery settings.

Purpose of the Study:

• To review the pathophysiology of coagulopathy in massively transfused patients.
• To highlight differences in coagulopathy between trauma and elective surgery.
• To discuss the impact of evolving blood products on management strategies.

Main Methods:

• Review of pathophysiology of coagulopathy in massively transfused patients.
• Analysis of differences in coagulopathy between trauma and elective surgery.
• Discussion on the evolution of blood products and their management implications.

Main Results:

• Trauma patients: uncontrolled tissue trauma, shock, hypothermia, and disseminated intravascular coagulation are common; coagulopathy monitoring is often delayed.
• Elective surgery patients: controlled environment, initial fibrinogen decrease, late thrombocytopenia; monitoring is ongoing, and treatment is simpler.
• Blood product availability has shifted, impacting treatment recommendations (e.g., fresh-frozen plasma as first-line).

Conclusions:

• Coagulopathy in massive transfusion remains a significant clinical challenge.
• Treatment strategies require adaptation based on the specific clinical context (trauma vs. surgery) and available blood products.
• Limited evidence supports current treatment options, necessitating further research for improved management of massively transfused patients.