Anaes SAQs · Perioperative medicine
Blood products and massive transfusion
Final-examination SAQ for blood-products-massive-transfusion.
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Activation (3). Activate early on clinical trajectory (shock, uncontrolled bleeding, predicted large-volume need)—not after delayed lab confirmation. Single-call pathway; identify patient, urgency, and ongoing need.[2][3]
Products/ratios (4). Empirical balanced packs (PROPPR 1:1:1 teaching plasma:platelets:RBC) rather than crystalloid floods; then goal-directed once viscoelastic/labs available; fibrinogen via cryoprecipitate/concentrate when indicated.[2][3]
TXA/calcium/temperature (4). TXA 1 g IV early then infusion per CRASH-2 if within 3 h of injury; monitor/replace ionised calcium (citrate chelation); active warming and product warmers to prevent lethal triad.[1][3]
ROTEM/TEG (4). High-level: low fibrinogen signal → fibrinogen; low clot strength → platelets after fibrinogen addressed; prolonged CT → factors/plasma; lysis → antifibrinolytic if indicated. Surgical haemostasis remains primary.[2]
References3ShowHide
- [1]Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death in trauma haemorrhage (CRASH-2). Lancet, 2010.PMID 20554319
- [2]Holcomb JB et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA, 2015.PMID 25647203
- [3]Spahn DR et al. European guideline major bleeding and coagulopathy after trauma. Critical Care, 2019.PMID 30917843