Hemostasis testing during massive blood replacement. A study of 172 cases

Area of Science:

• Surgical Medicine
• Hematology
• Transfusion Medicine

Background:

• Massive transfusion is a critical intervention for surgical patients with excessive bleeding.
• Hemostatic system derangements are common following massive transfusion.
• The efficacy of standard transfusion protocols in managing these derangements is questionable.

Purpose of the Study:

• To investigate the incidence and nature of hemostatic system changes in massively transfused surgical patients.
• To evaluate the effectiveness of standard transfusion protocols versus a targeted approach.
• To identify optimal strategies for managing hemostasis in this patient population.

Main Methods:

• Prospective 24-hour service study of 172 surgical patients undergoing massive transfusion.
• Comprehensive hemostasis testing including platelet count, prothrombin time, and plasma fibrinogen.
• Analysis of defined hemostatic disorders versus less specific laboratory abnormalities.

Main Results:

• 93% of patients exhibited abnormal hemostasis tests, most commonly affecting platelet count, prothrombin time, and plasma fibrinogen.
• Defined disorders (e.g., DIC) were found in 48%, while 45% had non-specific abnormalities potentially induced by transfusion volume.
• Standard component administration without hemostasis evaluation did not reduce abnormalities or blood product requirements.

Conclusions:

• Indiscriminate administration of blood components based on standard schemes is unjustified in massively transfused patients.
• A tailored approach involving hemostasis screening, disorder identification, targeted therapy, and monitoring is likely more effective.
• Personalized hemostasis management is crucial for improving outcomes in surgical patients receiving massive transfusions.