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Blood and coagulation support in trauma care
1Univ. of Maryland School of Medicine, Blood Bank, N2W50a, U Maryland Med Center, 22 South Greene Street, Baltimore MD 21201, USA. jhess@umm.edu
Hematology. American Society of Hematology. Education Program
|November 21, 2007
Summary
Severe injuries cause trauma-associated coagulopathy, a distinct syndrome beyond simple dilution. Early recognition and treatment of bleeding, acidosis, and hypothermia are crucial for managing this complex condition.
Area of Science:
- Trauma and Injury
- Hematology
- Critical Care Medicine
Background:
- Injuries are a leading cause of blood product utilization in the U.S.
- The traditional view of trauma-induced coagulopathy as solely dilutional is being challenged.
- Emerging evidence supports a distinct syndrome of trauma-associated coagulopathy.
Purpose of the Study:
- To review the pathophysiology of trauma-associated coagulopathy.
- To outline strategies for preventing and treating coagulopathy in trauma patients.
- To highlight the implications for plasma product availability.
Main Methods:
- Review of epidemiologic and molecular evidence.
- Analysis of the multifactorial nature of coagulopathy in trauma.
- Discussion of current and future treatment paradigms.
Main Results:
- Trauma-associated coagulopathy results from blood loss, dilution, consumption of coagulation factors and platelets, hypothermia, acidosis, and fibrinolysis.
- Prevention strategies include injury and hypothermia prevention.
- Treatment involves early recognition, hemorrhage control, and management of acidosis and hypothermia, potentially including plasma over crystalloids.
Conclusions:
- Trauma-associated coagulopathy is a complex syndrome requiring multifaceted management.
- Prompt intervention is key to improving outcomes.
- Increased use of plasma necessitates enhanced product availability and safety.
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