1. West Midlands Regional Training Package for Safe Blood Transfusion Practice The West Midlands Regional Transfusion Committee MODULE 13: Massive Transfusion
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4. Massive blood transfusion - procedure Module 13: Massive Transfusion Initial Resuscitation Oxygen should be administered. It is also important to maintain the patient’s body temperature (coagulation proteins may be less effective at lower temperatures, increasing the risk of blood loss). Crystalloids and/or synthetic colloids should be infused initially to restore circulating volume, until an acceptable systolic blood pressure is restored. Red cells should then be transfused to maintain adequate oxygen delivery to tissues. Laboratory tests should be performed as early as possible to obtain baseline values: FBC, PT, APTT, fibrinogen, biochemistry profile, blood gases and blood bank samples will be required. The FBC and coagulation samples should be repeated regularly to guide blood component replacement.
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7. Requesting of blood products - platelets Module 13: Massive Transfusion Platelet count will usually drop to <50 x 10 9 /l following 1.5 - 2 x blood volume replacement. An FBC sample must be taken before platelets are transfused. Target platelet count should be >75 x 10 9 /l (or >100 x 10 9 /l for multiple trauma or trauma involving CNS). Adults / larger child (>15kg) one adult therapeutic dose should be given. Neonate / small child 10 - 20 ml/kg body weight.
8. Requesting of blood products - fresh frozen plasma (FFP) Module 13: Massive Transfusion Remember: FFP requires approx 30 minutes thawing time Depletion of coagulation factors usually occurs after 1-1.5 x blood volume has been lost. A coagulation sample for PT, APTT and fibrinogen should be taken before FFP is transfused. FFP should be administered if the PT and/or APTT results are >2 x control. Target PT and PTT results should be <1.5 x control. Adults 12-15 ml/kg body weight or 4 units Neonate / small child 10-20 ml/kg body weight.
9. Requesting of blood products - cryoprecipitate Module 13: Massive Transfusion Remember: cryoprecipitate requires approx 30 minutes thawing time Cryoprecipitate should be considered to replace fibrinogen and factor VIII when the fibrinogen result is <1.0 g/l. Target fibrinogen level should be >1.0 g/l. Adults 2 packs of pooled cryoprecipitate
10. Pharmacological Support Module 13: Massive Transfusion Recombinant Factor VIIa (rFVIIa) May be available / considered. A recent trial has demonstrated that rFVIIa may have the potential to reduce the need for massive transfusion in penetrating trauma. In addition, mortality may be reduced in blunt trauma. Tranexamic Acid: Tranexamic acid can inhibit fibrinolysis by impairing fibrin dissolution. Is currently undergoing trials in bleeding associated with trauma. Beriplex: Beriplex is a prothrombin complex concentrate which can rapidly reverse the anticoagulant effect of warfarin should life threatening bleeding occur. The suggested dose is between 25 - 50u/kg and it should be used in conjunction with vitamin K. Beriplex should only be used in life-threatening situations for anticoagulation reversal, as it is potentially thrombogenic. It is contraindicated in patients with DIC or uncompensated liver disease.
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20. Module 13: Massive Transfusion Go to Answer Sheet Go to Module 14 Go to Index
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