Hemostasis in massively transfused trauma patients

Area of Science:

• Transfusion Medicine
• Hematology
• Critical Care Medicine

Background:

• Massive transfusions are critical in managing severe hemorrhage.
• Stored, modified whole blood is commonly used, but its impact on hemostasis requires clarification.

Purpose of the Study:

• To investigate if stored whole blood transfusions cause hemostatic disorders.
• To identify predictors of abnormal bleeding during massive transfusions.

Main Methods:

• Prospective study of 27 patients receiving massive transfusions.
• Monitoring of platelet counts and coagulation factors.
• Correlation of laboratory values with transfusion volume and bleeding events.

Main Results:

• Platelet counts decreased proportionally with blood units transfused.
• Abnormal bleeding occurred in 8 patients, primarily due to dilutional thrombocytopenia or DIC.
• Platelet concentrates controlled bleeding in most cases; fibrinogen levels aided DIC diagnosis.

Conclusions:

• Dilutional thrombocytopenia is a primary cause of bleeding after massive transfusions.
• Platelet counts are the most reliable predictor of bleeding risk.
• Platelet concentrates are recommended for managing bleeding; fresh blood products are generally unnecessary.