Management of massive blood loss: a template guideline

Abstract

The management of acute massive blood loss is considered and a template guideline is formulated, supported by a review of the key literature and current evidence. It is emphasized that, if avoidable deaths are to be prevented, surgeons, anaesthetists, haematologists and blood-bank staff need to communicate closely in order to achieve the goals of secure haemostasis, restoration of circulating volume, and effective management of blood component replacement.

Severe anemia: a case report

“…Transfusion is necessary to minimize symptoms and risks associated with symptomatic chronic anemia when hemoglobin is at 6 g/dl. Trials of acute normovolemic hemodilution in healthy volunteers and surgical patients found the limit of critical oxygen delivery in humans at about 50 g/l (12,13). Th e goal of early volume replacement is to delay or prevent the chain of events that leads to irreversible shock (13,15).…”

“…Trials of acute normovolemic hemodilution in healthy volunteers and surgical patients found the limit of critical oxygen delivery in humans at about 50 g/l (12,13). Th e goal of early volume replacement is to delay or prevent the chain of events that leads to irreversible shock (13,15). In hemorrhagic shock, the main management strategies are the arrest of bleeding and the replacement of circulating volume.…”

“…Rapid respiration and shortness of breath at rest should be considered as disturbing evidence of oxygen defi cit and evidence of cardiac decompensation. Dizziness and fainting are common as anemia progresses, but apprehension, changes in mentation and leg cramps are indications of severe oxygen deprivation and presage coma and death, or course that may lead to organ failure (1,11,12,13). When the amount of blood lost rapidly is equivalent to 30% of the blood volume, a subject may develop oligaemic shock (14).…”

Management of Critical Bleeding in Trauma Patients: Between Recommendations and Reality

“…Uncontrolled bleeding might be due to acquired coagulopathy as a result of trauma or surgery and due to defect of thrombin generation. By definition, life-threatening haemorrhage is a loss of entire blood volume within 24 hours, loss of 50% blood volume within 3 hours or blood loss exceeding 150 ml/min in 20 min or more [8,9].…”

1:1:1 – Warranted or wasteful? Even where appropriate, high ratio transfusion protocols are costly: early transition to individualized care benefits patients and transfusion services

“…Transfusion support in trauma is costly in several ways: wastage of blood components; depletion of O negative red blood cell (RBC) units and AB plasma; workload for hematologists and blood bank technologists; loss of product traceability; and the cost of oncall technologists. Arguably, some of these changes in services have been driven by new management protocols in acute severe hemorrhage [3], whose delivery has required substantial reorganization.…”