Blood products and massive transfusion

Meet the patient

A 30-year-old arrives in the emergency theatre with a penetrating abdominal wound, a systolic blood pressure of 70, and a positive focused abdominal scan. The transfusion pack is called before the first unit is hung, the blood bank runner is already moving, and the rapid infuser is warming.^[1]

The two questions that decide the next hour are the two that decide every massive haemorrhage: am I ahead of the bleed or behind it? and have I given the tranexamic acid and the calcium yet? Falling behind the bleed is how the lethal triad of hypothermia, acidosis and coagulopathy takes hold.^[1][3]

References6ShowHide

1. [1]Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial Lancet, 2010.PMID 20554319
2. [2]Holcomb JB, Tilley BC, Baraniuk S, 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. [3]Rossaint R, Afshari A, Bouillon B, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care, 2023.PMID 36859355
4. [4]Mazer CD, Whitlock RP, Fergusson DA, et al. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery N Engl J Med, 2017.PMID 29130845
5. [5]Holcomb JB, Jenkins D, Rhee P, et al. Damage control resuscitation: directly addressing the early coagulopathy of trauma J Trauma, 2007.PMID 17297317
6. [6]Roberts I, Shakur H, Afolabi A, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet, 2011.PMID 21439633