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Serial changes in primary hemostasis after massive transfusion.

C Harrigan, C E Lucas, A M Ledgerwood

    Surgery
    |October 1, 1985
    PubMed
    Summary
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    Massive transfusions in injured patients can cause low platelet counts and impaired platelet function. However, routine platelet transfusions are unnecessary for patients without active bleeding.

    Area of Science:

    • Hematology
    • Trauma Surgery
    • Transfusion Medicine

    Background:

    • Massive transfusion protocols are critical in managing severely injured patients.
    • Post-injury coagulopathy and thrombocytopenia are common complications.
    • The role of platelet function and transfusion thresholds requires further investigation.

    Purpose of the Study:

    • To evaluate primary hemostasis in injured patients receiving massive transfusions.
    • To assess platelet count, aggregation, and specific protein levels post-injury and post-transfusion.
    • To determine the necessity of routine platelet administration in trauma patients.

    Main Methods:

    • Studied 22 injured patients undergoing massive transfusions.
    • Monitored platelet count, bleeding time, and platelet aggregation (ADP, collagen) at multiple time points.

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  • Measured platelet-specific proteins (beta-thromboglobulin, platelet factor 4) in the operating room and postoperatively.

    • Main Results:

    • Platelet counts were low initially, decreasing post-surgery, then rising by day 4.
    • Prolonged bleeding times were observed through postoperative day 4.
    • Platelet aggregation remained depressed, while platelet-specific proteins were elevated then decreased.
    • No clinical oozing was noted despite significant alterations in platelet number and function.

    Conclusions:

    • Severely injured patients with massive transfusions exhibit significant platelet dysfunction.
    • Clinical bleeding is not consistently observed even with impaired platelet parameters.
    • Routine prophylactic platelet transfusion in trauma patients without active bleeding is not warranted.