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ABO Blood Group System ABO Mismatched Allogeneic Transplants Albumin Autoimmune Hemolytic Guidelines Blood Administration Blood Component Transfusion Guidelines Blood Donation CMV Negative Blood Components Compatibility Testing Cryoprecipitate Factor IX Complex Factor VIIa Factor VIII Concentrate Factor VIII Inhibitors Fresh Frozen Plasma Granulocyte Transfusion Hemolysis Following Allogeneic BMT Informed Consent Irradiated Blood Components Leukocyte Reduced Red Cells & Platelets Massive Transfusion Neonatal Alloimmune Thrombocytopenia Nitric Oxide Banked Blood Other Blood Group Systems Pediatric & Neonatal Transfusion Practices Platelet Transfusion Prenatal & Perinatal Immunohematologic Testing RBC Transfusion Trigger Red Blood Cell Transfusion Rh Blood Group System RhIG for HDN Prevention RhIG for Treatment of ITP Saline Washed Red Blood Cells Sickle Cell Disease Transfusion Therapeutic Apheresis Thrombotic Thrombocytopenic Purpura Transfusion Reactions Transfusion Related Acute Lung Injury Trypanosoma Cruzi Donor Screening Umbilical Cord Blood Stem Cells von Willebrands Disease Warm Autoimmune Hemolytic Anemia

Massive Transfusion

Massive transfusion is defined as the replacement of the patient's total blood volume by stored blood in less than 24 hours. The most important factor in the management of hypovolemic shock is to restore the circulating blood volume as rapidly as possible. Blood volume may initially be restored with crystalloid and colloid solutions. When blood loss and fluid replacement reach 40% of blood volume, transfusion of red cells is required. As soon as the need for massive transfusion is recognized, blood samples should be obtained for emergency laboratory tests including ABO and Rh type, antibody screen, compatibility testing, hemoglobin, platelet count, prothrombin time, and partial thromboplastin time. In cases of trauma in which the blood group of the patient is not known it may be necessary to start the transfusion with group O blood while the ABO group is ascertained.

Stored blood undergoes progressive losses, mainly of factors V and VIII. Platelet function is lost quickly in stored red blood cell products. In the past, standardized regimens of platelet concentrates and FFP have been ordered after the equivalent of one blood volume has been transfused. However, this practice often results in unnecessary transfusion of FFP and platelets. FFP usage should be restricted to correcting proven prolongation of the prothrombin time or activate plasma partial thromboplastin time.

Thrombocytopenia, rather than coagulation factor depletion, appears to be the primary cause of bleeding in many patients. Thrombocytopenia may be aggravated by increased consumption of platelets so that defining the appropriate dose of platelets is impossible without monitoring the platelet count. Acute disseminated intravascular coagulation should be suspected when the fibrinogen level decreases precipitously. About 10 units of cryoprecipitate should be given in addition to FFP to correct the deficiencies of fibrinogen and factor VIII. The fibrinogen level should be kept above 100 mgdL. The need for additional hemostatic treatment should continue to be monitored by clinical response and repeated laboratory tests.