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[Blood transfusion and adjunctive therapy in the bleeding trauma patient].
- Source :
-
Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine [Transfus Clin Biol] 2008 Nov; Vol. 15 (5), pp. 240-5. Date of Electronic Publication: 2008 Oct 17. - Publication Year :
- 2008
-
Abstract
- Uncontrolled hemorrhage is the most common cause of potentially preventable death in massive trauma. In addition to the early identification of potential bleeding sources and angiographic embolisation or surgical bleeding control, in-hospital management will aim at maintain tissue oxygenation with volume replacement using crystalloids, colloids and RBC. In general, RBC transfusion is recommended to maintain hemoglobin between 7-10g/dL. The complex combination of clotting factors and platelets consumption, loss and dilution, shock, hypothermia, acidosis and colloid-induced hemostatic alterations leads to coagulopathic bleeding. Most guidelines recommend the use of FFP in significant bleeding complicated by coagulopathy (PT, aPTT >1.5 times control). Platelets should be administered to maintain a platelet count above 50 x 10(9)/L (100 x 10(9)/L in patients with traumatic brain injury). However, standard laboratory tests have poor correlation with in vivo coagulopathy and the test results are not rapidly available. Empiric guidelines derived from mathematical hemodilution models developed in elective surgery settings may not be appropriate for trauma settings where significant bleeding may have already occurred. Moreover, coagulopathy is frequently present on admission in severely injured patients. Recent litterature suggests that FFP and platelets should be given early and more often to injured patients requiring massive transfusion. The place of adjunctive hemostatic therapy is discussed.
- Subjects :
- Adult
Blood Coagulation Factors therapeutic use
Blood Component Transfusion standards
Combined Modality Therapy
Disseminated Intravascular Coagulation etiology
Disseminated Intravascular Coagulation prevention & control
Emergencies
Fluid Therapy adverse effects
Hemorrhage etiology
Hemostatic Techniques
Hemostatics therapeutic use
Humans
Hypovolemia etiology
Hypovolemia therapy
Plasma
Practice Guidelines as Topic
Wounds and Injuries physiopathology
Blood Transfusion standards
Hemorrhage therapy
Wounds and Injuries complications
Subjects
Details
- Language :
- French
- ISSN :
- 1246-7820
- Volume :
- 15
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine
- Publication Type :
- Academic Journal
- Accession number :
- 18930423
- Full Text :
- https://doi.org/10.1016/j.tracli.2008.09.010