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Massive transfusion coagulopathy.

Jerrold H Levy1

  • 1Department of Anesthesiology, Emory University School of Medicine, Cardiothoracic Anesthesiology and Critical Care, Emory Healthcare, Atlanta, GA 30322, USA. Jerrold.Levy@emoryhealthcare.org

Seminars in Hematology
|January 24, 2006
PubMed
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Massive transfusion can cause bleeding due to hypothermia, dilutional coagulopathy, and platelet issues. Agents like aprotinin and recombinant activated factor VII show promise in preventing and treating surgical hemorrhage.

Area of Science:

  • Trauma and Surgical Hemorrhage Management
  • Transfusion Medicine
  • Coagulation Disorders

Background:

  • Coagulopathy is a significant complication following massive transfusion in trauma and surgical patients.
  • Causes include hypothermia, dilutional coagulopathy, platelet dysfunction, fibrinolysis, and hypofibrinogenemia.
  • Massive transfusion (15-20 units) leads to dilutional thrombocytopenia, exacerbated by antiplatelet agents and hemostatic inhibitors.

Purpose of the Study:

  • To review the causes of coagulopathy after massive transfusion.
  • To discuss current and potential therapeutic agents for hemorrhage prophylaxis and treatment.

Main Methods:

  • Literature review of coagulopathy following massive transfusion.
  • Analysis of contributing factors to bleeding in surgical and trauma patients.

Related Experiment Videos

  • Evaluation of prophylactic and rescue therapies for hemorrhage.

    • Main Results:

    • Dilutional thrombocytopenia, hypofibrinogenemia, and excessive fibrinolysis are key contributors to bleeding.
    • Platelet function tests are not widely available.
    • Aprotinin and off-label recombinant activated factor VII show efficacy in hemorrhage control.

    Conclusions:

    • Understanding the multifactorial nature of coagulopathy is crucial for effective management.
    • Aprotinin and recombinant activated factor VII represent valuable options for hemorrhage prophylaxis and rescue therapy in specific surgical contexts.