Problems with 20 or more blood transfusions in 24 hours

Area of Science:

• Transfusion Medicine
• Critical Care Medicine
• Hematology

Background:

• Massive transfusions, defined as 20 or more units of blood within 24 hours, are critical interventions for severe hemorrhage.
• The outcomes and complications associated with such massive transfusions require thorough investigation to optimize patient management.

Purpose of the Study:

• To review the outcomes of patients receiving massive transfusions.
• To identify factors associated with mortality in patients undergoing massive transfusions.

Main Methods:

• Retrospective review of 128 patients who received 129 massive transfusions (≥20 units/24h) between August 1980 and August 1985.
• Analysis of mortality rates based on the number of blood units transfused, presence of shock, and pre-existing disease.
• Evaluation of laboratory parameters including platelet counts, prothrombin time (PT), partial thromboplastin time (PTT), and calcium levels.

Main Results:

• Mortality rates increased significantly with the number of blood units transfused and the presence of shock or pre-existing disease, reaching 100% in patients receiving ≥50 units.
• Coagulopathy was clinically diagnosed in 43 patients, but laboratory findings (low platelets, prolonged PT/PTT) did not consistently correlate with plasma product administration.
• Hypocalcemia (total calcium <6.0 mg/dL) and low ionized calcium (<0.70 mmol/L) were prevalent, affecting over 50% of assessed patients.
• Deaths were primarily due to continued bleeding/shock (76%) or severe infections (15%) occurring later.

Conclusions:

• Massive blood transfusions are associated with high mortality, particularly in patients with shock and pre-existing comorbidities.
• Coagulopathy and hypocalcemia are frequent complications that may not correlate well with standard laboratory monitoring or interventions.
• Further research is needed to improve management strategies for patients requiring massive transfusions to reduce mortality and morbidity.