Transfusion Therapy for Massive Hemorrhage

Abstract

Massive hemorrhage is a major complication of traumatic injury and many surgical operations. Early detection of hemorrhage and appropriate resuscitation is essential to improve outcomes during recovery from the inciting event. Traumatic injury, surgical exposure, and large-volume resuscitation can cause physiologic derangements that result in alterations of the normal coagulation cascade and formation of thrombin clot. Careful balancing of resuscitation using appropriate ratios of packed red blood cells (pRBCs), fresh frozen plasma (FFP), and platelets as well as avoiding crystalloid solutions have been shown to decrease mortality, likely due to improved hemostasis. Additionally, careful evaluation of laboratory values, patient history and pharmacologic exposure can further guide resuscitation efforts and provide information for potential pharmacological intervention.