Week 12 Transfusion Management PDF
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Uploaded by SuccessfulJuniper
The University of Adelaide
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Summary
This document discusses transfusion management for patients with critical bleeding and coagulopathy. It covers the characteristics of critical bleeding and massive transfusions, as well as the pathophysiology of hemorrhagic shock and the lethal triad. Topics also include microvascular bleeding, trauma induced coagulopathy, and risk factors for coagulopathy.
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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
