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massive blood transfusion (washout)
Replacement of more than one blood volume (10 units of blood) in < 24 hours.
Pathology:
1) coagulopathy & thrombocytopenia from replacement with erythrocytes & crystalloid (deficiency in platelets & coagulation factors)
2) qualitative platelet defect
3) diffuse microvascular bleeding from wounds & other traumatized sites
4) disseminated intravascular coagulation (may be related to shock)
5) systemic fibrinolysis may occur in patients with severe liver disease
6) sudden decreases in plasma Ca+2 can occur as a result of infusions of citrated plasma (especially in patients with severe liver disease unable to rapidly clear citrate from circulation)
Clinical manifestations:
1) hypotension
2) hypothermia
Laboratory:
1) prothrombin time (PT) & aPTT prolonged
2) plasma fibrinogen low
3) platelet count: mild thrombocytopenia (50,000-100,000/uL)
4) arterial blood gas: metabolic acidosis
5) monitor for electrolyte disturbances & metabolic alkalosis
- hypocalcemia, hyperkalemia, hypokalemia
- basic metabolic panel [1]
Management:
1) replacement of blood loss with fresh whole blood*
2) prophylactic platelet transfusions NOT helpful
3) replace specific factors as indicated by laboratory assessment
a) packed red blood cells (RBC)
b) fresh frozen plasma
c) platelets
4) use of blood warmers
* generally NOT available
Related
disseminated intravascular coagulation (DIC)
hypocalcemia
systemic fibrinolysis (fibrinolytic disorder)
General
blood transfusion
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 18, 19.
American College of Physicians, Philadelphia 1998, 2018, 2022.