Review article: transfusion in gastrointestinal haemorrhage-if, when and how much? (original) (raw)
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Resuscitation of the trauma patient: tell me a trigger for early haemostatic resuscitation please!
Critical Care, 2011
Stanworth and colleagues have explored the relation between blood loss and mortality in trauma patients in a study stimulated by the changing approach to early trauma management . Th e traditional approach advocates packed red blood cell (PRBC) transfusions and early coagulation testing in the hospital laboratory using assays such as the prothrombin time ratio, the activated partial thromboplastin time ratio, and platelet concentration. Transfusion of fresh frozen plasma, platelets, and sometimes cryoprecipitate was based on results that may be delayed for 60 minutes following sampling. Current guidelines recommend transfusion when prothrombin time ratio or activated partial thromboplastin time ratio >1.5, platelet count <50 × 10 9 /l, or fi brinogen level <1.5 to 2.0 g/l [2], or after a certain proportion of the circulating volume is lost. Th is approach is inherently reactive rather than proactive and is at risk of closing the door after the horse has bolted. Our increasing understanding that shock and hypoperfusion can initiate infl ammation, which is closely linked to coagulation, creates biological plausibility that the traditional approach may not be best for injured patients.
Massive transfusion in traumatic shock
The Journal of emergency medicine, 2013
Hemorrhage after trauma is a common cause of death in the United States and globally. The primary goals when managing traumatic shock are the restoration of oxygen delivery to end organs, maintenance of circulatory volume, and prevention of ongoing bleeding through source control and correction of coagulopathy. Achieving these goals may require massive transfusion of blood products. Although use of blood products may be lifesaving, dose-related adverse effects are well described. Complications of massive transfusion include interdependent derangements such as coagulopathy, hypothermia, acidosis, and electrolyte abnormalities, as well as infectious and immunomodulatory phenomena. This article explores the pathogenesis, implications, prevention, and treatment of these complications through the use of massive transfusion protocols. Particular attention is given to the optimal ratio of blood products transfused in large volume resuscitation and prevention of secondary coagulopathy. Obse...
Review of Blood Transfusion Strategies among Trauma Patients
Global Journal of Hematology and Blood Transfusion, 2015
Introduction: Trauma is the third most common cause of mortality worldwide and leading cause of death in the age group 1 to 44 years. Among those trauma patients, major hemorrhage is responsible for 30 to 40% of mortality, despite the fact that it could be preventable and reversible. The ideal resuscitation strategy for trauma patients remains a topic of ongoing debate. Transfusion services stress trauma centers with demands for strict accountability for individual blood component units and adherence to indications in a clinical field where research has been difficult and guidance opinion-based. New data suggest that the most severely injured patients arrive at the trauma center already coagulopathic and these patients benefit from prompt specific and corrective treatment. At present, no consensus has been reached on ideal fluid for early resuscitation and on the threshold for blood product transfusions. This review article provides a brief overview of recent advances in trauma induced hematological complications, role of pathologist in managing them and subsequent complicating issues. Thereby, covering the widest possible body of literature. Aims and objectives: In this review we address ongoing resuscitation strategies along with potential complications in management of the trauma patients. This review also assesses the still ongoing, controversial debate of the best fit treatment options. This research is clarifying trauma system requirements for new blood products and blood-product usage patterns, but the inability to obtain informed consent from severely injured patients remains an obstacle to further research. Methods: We considered systematic reviews identified through searches of Cochrane databases from inception to April 2015 and PubMed up to April 2015. Results and Conclusions: Polytrauma patients with severe shock from haemorrhage and massive tissue injury present major challenges for management and resuscitation. Many of the current recommendations for damage control resuscitation remain controversial. A lack of large, randomized, control trials leaves most recommendations at the level of consensus and expert opinion. Ongoing trials and improvements in monitoring and resuscitation technologies will further influence how we manage these complex and challenging patients.
Transfusion practices in traumatic brain injury
Current opinion in anaesthesiology, 2018
The aim of this review is to summarize the recent studies looking at the effects of anemia and red blood cell transfusion in critically-ill patients with traumatic brain injury (TBI), describe the transfusion practice variations observed worldwide, and outline the ongoing trials evaluating restrictive versus liberal transfusion strategies for TBI. Anemia is common among critically-ill patients with TBI, it is also thought to exacerbate secondary brain injury, and is associated with an increased risk of poor outcome. Conversely, allogenic red blood cell transfusion carries its own risks and complications, and has been associated with worse outcomes. Globally, there are large reported differences in the hemoglobin threshold used for transfusion after TBI. Observational studies have shown differential results for improvements in cerebral oxygenation and metabolism after red blood cell transfusion in TBI. Currently, there is insufficient evidence to make strong recommendations regarding...
Transfusion of Blood Products in Trauma: An Update
The Journal of Emergency Medicine, 2010
e Abstract-Background: Blood transfusion in the management of severely injured patients can be lifesaving. These patients are susceptible to developing early coagulopathy, thus perpetuating bleeding. Objectives: This article presents recent advances in both the civilian and military clinical arena to improve the treatment of trauma patients with severe hemorrhage, the use of agents to support coagulation, perspectives on restrictive transfusion strategies, and transfusion-related risks. Discussion: Massive blood transfusion is an adjunct to surgical care. The volume of blood products transfused and the ratio of blood components have been associated with increased morbidity and mortality rates. The adverse clinical effects of transfusion and the limited supply of blood products have resulted in modern resuscitation protocols to limit the volume of blood transfused. Conclusion: A restrictive blood transfusion strategy and the use of hemostatic agents may decrease morbidity and mortality in trauma patients, but insufficient data are available for their use in trauma patients. Massive transfusion should reflect an equal ratio of packed red cells and plasma to limit coagulopathy. Prospective randomized trials are needed to standardize an effective protocol.
Colombian Journal of Anesthesiology, 2012
Massive transfusion is considered a key component in the acute management of massive hemorrhage. While the existing protocols do not standardize its use, they do recommend its timely administration and a dose adjusted to the type of blood product, a proportionate ratio between hemocomponents and appropriate adjuvant drug support, in addition to techniques that promote bleeding control and prevent syndromes that could trigger a fatal outcome. This non-systematic review is intended to summarize the current concepts on the acute management of massive bleeding in trauma, from a non-surgical perspective. The search was limited to the articles of the last 10 years and included primary and secondary data basis, leading to a snowball technique.
Journal of Surgical Research, 1996
The benefit of early fluid resuscitation has been quesblood loss and mortality. We determined the effects of tioned after both blunt and penetrating trauma [1][2][3]. infusion rate and time of resuscitation on blood loss The main reason for postponing volume replacement and mortality and compared the outcome to nonresusuntil after major bleeding sites have been surgically citated animals in severe, uncontrolled hemorrhagic controlled is the concern that aggressive fluid resuscishock in a rat model. In anesthetized rats, piercing of tation may disrupt the natural hemostatic mechanisms the infrarenal aorta with a 25-G needle caused a fall by preventing the formation of or disrupting the clots of mean arterial pressure to õ20 mm Hg and blood loss from injured blood vessels, leading to increased or reof about 20 ml/kg in 90% of the animals. Animals were current hemorrhage and decreased survival. assigned to the following treatment groups (n Å 6): 60 Several experimental models have been used to demml/kg of lactated Ringer's solution (LR) infused at a onstrate the causal relationship between early fluid rerate of 1.5 ml/min and given at 2.5 min (Group I), 5 suscitation and increased blood loss and mortality min (Group II), or 10 min (Group III) postinjury, or LR when compared to nonresuscitated animals [4][5][6][7][8]. In infused at a rate of 3.0 ml/min and given at 5 min many of the studies, however, the rate of infusion of (Group IV) or 10 min (Group V) postinjury. Another the resuscitative fluid has been very high and the time group (n Å 9) was not resuscitated. The animals were interval between injury and resuscitation very short, followed for 3 hr. Total blood loss in Group I (30.5 { which may have contributed significantly to the risk of 2.6 ml/kg) was significantly (P õ 0.05) higher when increased blood loss and mortality. compared to nonresuscitated animals (22.1 { 0.8 ml/ Animal models of uncontrolled hemorrhage simukg) or Group III (22.7 { 1.0 ml/kg), and also signifilate the hemodynamic events leading to hemorrhagic cantly higher in Group IV (35.8 { 4.1 ml/kg) when comshock following trauma by reproducing the primary pared to nonresuscitated animals or Group V (23.0 { pathophysiologic event, a blood vessel injury [9]. In 1.2 ml/kg). The mortality rate was 7/9 in nonresuscia rat, the blood vessel injury has been induced by tail tated animals and 5/6 in Group IV; both were signifitransection at different points ranging from 8 to 75% cantly higher than in Groups II, III, and V (0 or 1/6) and of the tail length [6, 10 -14] or by an abdominal vasmarkedly higher than in Group I (2/6). Conclusions: In cular injury such as transection of cecal branches of this model of uncontrolled hemorrhage, initially unan ileocolic artery and vein [8], a combination of precorrected severe shock resulted in a high mortality bleeding of 20 ml/kg and incision of three major rate. The risk of increased blood loss and mortality branches of the ileocolic artery [4], or a combined associated with early fluid resuscitation could be dihepatic and retrohepatic caval vein injury [15]. In minished by avoiding too fast of infusion rates early swine models, the vascular injury has been produced after the injury. ᭧ 1996 Academic Press, Inc.