week 12 Transfusion Management of Patients with Critical Bleeding & Coagulopathy (1).pdf

Haemorrhage of a small volume in a critical area or...

Haemorrhage of a small volume in a critical area or Characteristics of critical bleeding organ (e.g., intracranial) Major haemorrhage that is life threatening Critical Bleeding & Massive Transfusion Blood loss rate e 150 mL/min 50% total blood volume replaced over 3 hrs Transfusion of 4 RCs within 1 hr or 1 total Characteristics of massive transfusion: blood volume over 24 hrs Loss of 1.5 ml blood/kg/min over 20 mins e5RCs in any 4hr period Unique clotting disorder following trauma Failure of blood to clot normally in Coagulopathy response to tissue injury Trauma Induced Coagulopathy (TIC): Alterations in endothelial function, fibrinolysis regulation, and platelet behaviour disruption in the small blood vessels, leading to diffuse bleeding into tissues Microvascular bleeding and organs. Compensatory vasoconstriction Hypoperfusion = Hypovolaemia & Acute Anaemia Compensatory metabolic acidosis Coagulopathy/Microvascular Hypothermia Bleeding Key pathophysiology of Haemorragic LethalTriad shock: Acidosis –Hypothermia –Coagulopathy Renal Injury Systemic Inflammatory Response Late Syndrome Consequences Injury Severity Score: > 25 Hepatic Impairment Gut Ischaemia pH: < 7.10 Risk Factors for Coagulopathy 4 Major independent risk factors: Bone MarrowSuppression Systolic Blood Pressure: < 70 mmHg Hypothermia: < 34°C Appropriate use of blood components to correct coagulopathy: Early goal-directed coagulation Therapeutic Goals - Patient management: Surgical bleeding ’ coagulopathy Blood Management Rapid control of bleeding Prevent/minimise coagulopathy Goals: Avoid unnecessary transfusions Minimise end organ dysfunction impaires formation of platelet plug increase fibrolytic activity resulting in Hypothermia Effect of Hypothermia cougulpthy Acid/base (pH) derangements (acidosis) Hypocalcaemia, hypomagnesaemia (citrate Complications toxicity) Hyper or hypokalaemia Dilutional coagulopathy Temperature 4 mmol/L Ionised calcium 1.5; PT >18 seconds; aPTT >45 seconds Fibrinogen level