week 12 massive blood transfusion

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Questions and Answers

What is the rate of blood loss in massive bleeding?

e 150 mL/min

What is the result of microvascular bleeding?

Disruption in the small blood vessels, leading to diffuse bleeding into tissues and organs

What is the criteria for massive transfusion?

Transfusion of 4 RCs within 1 hr or 1 total blood volume over 24 hrs

What is the consequence of losing 1.5 ml blood/kg/min over 20 mins?

Massive transfusion Signup and view all the answers

What is the result of alterations in endothelial function, fibrinolysis regulation, and platelet behaviour?

Trauma Induced Coagulopathy (TIC) Signup and view all the answers

What is the key pathophysiology of Haemorrhagic shock?

Hypoperfusion, Hypovolaemia, Acute Anaemia, Coagulopathy, and Metabolic acidosis Signup and view all the answers

What are the three components of the Lethal Triad?

Acidosis, Hypothermia, and Coagulopathy Signup and view all the answers

What is the main goal of early goal-directed coagulation management?

Rapid control of bleeding and prevention of coagulopathy Signup and view all the answers

What is the effect of Hypothermia on coagulation?

Impairment of platelet plug formation and increased fibrinolytic activity Signup and view all the answers

What are the four major independent risk factors for Coagulopathy?

Bone Marrow Suppression, Systolic Blood Pressure < 70 mmHg, Hypothermia < 34°C, and pH < 7.10 Signup and view all the answers

What is the effect of Hypocalcaemia on coagulation?

Impaired coagulation due to Citrate toxicity Signup and view all the answers

What is the target temperature in blood component management?

≥ 34°C Signup and view all the answers

What is the goal of therapeutic blood management in Haemorrhagic shock?

Minimise end organ dysfunction and avoid unnecessary transfusions Signup and view all the answers

Risk Factors for Coagulopathy

Injury Severity Score: > 25 pH: < 7.10 Systolic Blood Pressure: < 70 mmHg Hypothermia: < 34° Signup and view all the answers

Therapeutic Consideration

Correct pH & temp Explore traumatic/surgical source of bleeding Avoid excessive dilution with colloids/crystalloids Anti-fibrinolytics First line Fgn Plt transfusion Facilitate thrombin generation with PCC or FFP Signup and view all the answers

What are the potential complications of massive blood transfusion?

o dilutional coagulopathy, hypocalcemia, hypomagnesemia, hyperkalemia, hypothermia, acid-base disturbances, transfusion-related acute lung injury (TRALI), and transfusion-associated circulatory overload (TACO) Signup and view all the answers

How can hypocalcemia occur during a massive transfusion, and what are its signs and symptoms

Hypocalcemia can occur due to the citrate used as an anticoagulant in stored blood products, which binds to calcium in the recipient’s blood. Signs and symptoms include muscle cramps, tetany, paresthesias, prolonged QT interval on ECG, and, in severe cases, cardiac arrest Signup and view all the answers

what are 4 major independent risk factors for coagulopathy

Injury Severity Score: > 25 pH: < 7.10 Systolic Blood Pressure: < 70 mmHg Hypothermia: < 34°C Signup and view all the answers

Tranexamic acid is given in massive haemorrhage because it

inhibits plasminogen activation, preventing fibrinolysis and promoting blood clot stability Signup and view all the answers

Study Notes

Critical Bleeding and Massive Transfusion

Characteristics of critical bleeding: haemorrhage of a small volume in a critical area (e.g., intracranial) or major haemorrhage that is life-threatening
Blood loss rate of ≥ 150 mL/min, 50% total blood volume replaced over 3 hours, or transfusion of 4 RCs within 1 hour or 1 total blood volume over 24 hours
Loss of 1.5 ml blood/kg/min over 20 minutes, or ≥5 RCs in any 4-hour period

Coagulopathy

Unique clotting disorder following trauma, characterized by failure of blood to clot normally in response to tissue injury
Trauma Induced Coagulopathy (TIC): alterations in endothelial function, fibrinolysis regulation, and platelet behavior

Microvascular Bleeding

Disruption in the small blood vessels, leading to diffuse bleeding into tissues and organs
Compensatory vasoconstriction, hypoperfusion, and acute anaemia, resulting in compensatory metabolic acidosis

Coagulopathy and Microvascular Bleeding

Key pathophysiology of Haemorrhagic Shock: Lethal Triad - Acidosis, Hypothermia, and Coagulopathy
Risk factors for Coagulopathy: Injury Severity Score > 25, Hepatic Impairment, Gut Ischaemia, pH < 7.10, Bone Marrow Suppression, Systolic Blood Pressure < 70 mmHg, and Hypothermia < 34°C

Therapeutic Goals - Patient Blood Management

Appropriate use of blood components to correct coagulopathy
Early goal-directed coagulation management: rapid control of bleeding, prevent/minimise coagulopathy, avoid unnecessary transfusions, and minimise end-organ dysfunction

Complications of Coagulopathy

Hypothermia: impairs formation of platelet plug, increases fibrinolytic activity, resulting in coagulopathy
Acid-base (pH) derangements (acidosis)
Hypocalcaemia, hypomagnesaemia (citrate toxicity)
Hyper or hypokalaemia
Dilutional coagulopathy
Ionised calcium < 1.5, PT > 18 seconds, aPTT > 45 seconds, and fibrinogen level < 4 mmol/L

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