Trauma-induced coagulopathy and critical bleeding: the role of plasma and platelet transfusion

Abstract

Hemorrhage is responsible for 30 to 40% of all trauma-related mortality. Among adult trauma patients, 94% of hemorrhage-related deaths occur within 24 h and approximately 60% of these deaths within 3 h of hospital admission. Therefore, appropriate initial fluid resuscitation for bleeding is crucial to avoid preventable traumarelated death. In particular, the resuscitation strategy must be designed to complement prompt correction of anemia, coagulopathies, and thrombocytopenia. Conventional damage control resuscitation (DCR) of patients with severe trauma and massive hemorrhage is usually begun with rapid infusion of 1000 to 2000 mL of crystalloid fluids with subsequent transfusion of type O or uncross-matched red blood cells (RBCs) without plasma such as fresh frozen plasma (FFP) or platelets (PLTs). However, this DCR technique often leads to several adverse events such as abdominal compartment syndrome, acute respiratory distress syndrome, multiple organ failure, and dilutional coagulopathy. Simultaneous transfusion of FFP and PLTs along with the first units of RBCs while minimizing crystalloid infusion was recently recommended as a renewed DCR strategy. This aggressive RBC transfusion with FFP and PLTs is not only essential for the correction of coagulopathies and thrombocytopenia but also has the potential to ensure a good outcome in trauma patients. Additionally, it is important to maintain the resuscitation ratios of FFP/RBC and PLT/RBC. Most recently, DCR has been advocated for rapid hemorrhage control through early administration of a mixture of FFP, PLTs, and RBCs in a balanced ratio of 1:1:1.

Platelet adenosine diphosphate receptor inhibition provides no advantage in predicting need for platelet transfusion or massive transfusion

“…While platelet count predicts outcome, transfusing platelets based on platelet count to “normalize” platelet count does not seem to improve outcomes, and may even harm patients, if the internal environment is hostile [21]. The appropriate transfusion trigger for platelets in injured patients remains to be elucidated but goal-directed platelet transfusions with TEG MA have been associated with a reduction in platelet transfusions and a reduction in mortality in patients undergoing massive transfusion [7,22,23]. …”

Massive transfusion triggers in severe trauma: Scoping review

“…The new tendencies report Fibrinogen and BE ( 46 , 49 - 50 ) as individual predictors of MT, which stand out because they diminish early, even before the other coagulation factors ( 49 ) . The prothrombin time (PT) and the activated partial thromboplastin time (aPTT) ( 46 , 51 ) , among others, used to determine Acute Traumatic Coagulopathy (ATC) are examined using the PROMMTT sample ( 52 ) and its subsequent investigations ( 34 , 46 , 53 ) , which show their alteration but do not determine a fixed interval with regard their definition.…”

Clinical efficacy of platelet transfusion therapy in patients with leukemia and analysis of risk factors for ineffective transfusion

“…Some studies have shown that the disorder of the body's internal environment and the production and release of platelet antibodies in patients with leukemia would affect the maturation of platelets and cause damage to them, leading to a decrease in the number of platelets in patients (21). Platelet transfusion therapy can enhance the intracellular platelet density of patients through matching of blood after transfusion, to prevent the deterioration of patients' condition caused by hemorrhage (22). In clinical practice, CCI, PPR and patients' hemorrhage status were used as the criteria to assess the efficacy of platelet transfusion (23).…”