Transfusion Management of Trauma Patients. Beth H. Shaz, Christopher J. Dente, Robert S. Harris, Jana B. MacLeod, Christopher D. Hillyer.

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Transfusion Management of Trauma Patients.Beth
H. Shaz, Christopher J. Dente, Robert S. Harris,
Jana B. MacLeod, Christopher D. Hillyer.

• ANESTHESIA and ANALGESIA.
• Vol.108, No.6, June 2009
• P1760- 1768.

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Early Trauma related Mortality.

• Head Injury 40 - 50 deaths.
• Haemorrhage 20 - 40 deaths.

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Recognised treatment strategies for traumatic
major haemorrhage.

• PALS/APLS.
• ATLS.
• Component approach.
• Hypotensive resuscitation.

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Traditional perceived causes of coagulopathy.

• Dilution secondary to fluid resuscitation
  developing over hours.
• Hypothermia.
• Acidosis.
• Consumption.

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Early trauma-induced coagulopathy.

• Occurs in 25 of trauma victims.
• INRgt1.5
• Independent predictor of mortality with
  associated 35 increase in likelihood of dying .

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Massive Transfusion Protocols based on experience
from Military Hospitals.

• Early administration of blood products.
• Predetermined blood product ratios of ideally
  111 PRBCs, FFP, platelets or even whole blood.
• AVOID HYPOTHERMIA,ACIDOSIS AND COAGULOPATHY.

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Mortality related to plasmaRBC ratio.
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Risks of transfusion.

• Hypothermia.
• Hyperkalaemia.
• Acidosis.
• Hypocalcaemia.
• TRALI.
• MOF.
• Infection.

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Major Transfusion Protocols for Children.

• Major haemorrhage in children is a rare event.
• Are children more susceptible to the hazard of
  Massive Transfusion?
• The mortality rate in children of 8yrs. or less
  is 18 v 4 for older children and adults! (Iraq
  2003-2008 NEJM April 16, 2009).