Coagulation defects associated with massive blood transfusion: A large multicenter study.

Area of Science:

• Hematology
• Transfusion Medicine
• Surgical Critical Care

Background:

• Massive blood transfusions are critical in managing severe hemorrhage during surgery.
• Understanding coagulation dynamics during massive transfusion is essential for patient outcomes.
• Previous studies have yielded varied results on coagulation index changes.

Purpose of the Study:

• To investigate variations in coagulation indices during massive packed red blood cell (pRBC) transfusion.
• To analyze trends in platelet counts and traditional coagulation parameters.
• To compare theoretical platelet estimates with actual measurements.

Main Methods:

• Retrospective analysis of 1,601 surgical inpatients receiving massive transfusions.
• Evaluation of coagulation indices at 16 time points during pRBC transfusion (2-40 units).
• Linear regression analysis to assess trends in platelet count, prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen (FIB).

Main Results:

• Platelet count showed a significant linear decrease with increasing pRBC units (Y=150.460‑3.041X).
• Average platelet count dropped below 75x10(9)/l after transfusing 18 units of pRBC.
• No pronounced trends were observed in the means of PT, INR, APTT, and FIB.
• Actual platelet counts were consistently higher than theoretical estimates.

Conclusions:

• Platelet count decreases linearly with the volume of pRBC transfused.
• Traditional coagulation indices (PT, INR, APTT, FIB) did not show significant variations.
• Actual platelet counts exceed theoretical predictions, necessitating vigilant monitoring during massive transfusions.