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Massive Blood Transfusion

Massive Blood Transfusion. Massive transfusion, defined as the replacement by transfusion of more than 50 percent of a patient's blood volume in 12 to 24 hour, may be associated with a number of hemostatic and metabolic complications . Bleeding due to Dilution of clotting factors.

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Massive Blood Transfusion

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  1. Massive Blood Transfusion • Massive transfusion, defined as the replacement by transfusion of more than 50 percent of a patient's blood volume in 12 to 24 hour, • may be associated with a number of hemostatic and metabolic complications

  2. Bleeding due to Dilution of clotting factors • Patients receiving large volumes of blood can develop a bleeding disorder due to dilution of coagulation factors & platelets • Stored blood has low levels of the: • clotting factors VIII and V • Does not contain functional platelets • Significant depletion occur when patient’s blood is replaced more than twice within 24 hrs

  3. The administration of: • platelet concentrates • cryoprecipitate • and fresh frozen plasma • can prevent this complication to patients receiving massive transfusions

  4. Citrate Toxicity & Hypocalcemia • Large amounts of citrate are given with massive blood transfusion • Since blood is anticoagulated with sodium citrate. • A decline in the plasma free calcium concentration is the potential complication of citrate infusion and accumulation. • Calcium supplements should be given if patient has evidence of hypocalcemia • This rarely occur unless one unit is given every 5 minutes or a patient has impaired liver function

  5. Hypothermia • Rapid transfusion of multiple units of chilled blood may reduce the core temperature abruptly • This can lead to cardiac arrhythmias. • This also increases the affinity of Hb to O2 resulting in poor O2 delivery to tissues • Thus, during massive transfusion, a commercial blood warmer should be used to warm blood toward body temperature during infusion.

  6. 2,3 DPG Deficiency • During storage erythrocytes concentration of 2,3-DPG falls • This increases affinity of Hb to O2 → less efficient in delivery of O2 • Rapid infusion of 2,3-DPG depleted cells could contribute to tissue hypoxia • Transfused blood regenerates 2,3-DPG within hours of infusion • Also, the use of CPD-A avoid this problem as rate of depletion decreases gradually

  7. Hyperkalemia • Plasma potassium levels in stored blood increase due to passive leakage of potassium out of red cells • By 3 weeks the level is approx. 30 mEq/l • This excess potassium does not usually lead to a significant rise in the plasma potassium concentration due to movement into the cells, urinary excretion, and dilution. • However, infants and patients with renal impairment may develop hyperkalemia.

  8. Microemboli • During storage, white cell & platelet fragments aggregate to form microscopic debris or microemboli • These can pass through standard blood bank filters • They can embolize to the lungs, but have not been reported to cause morbidity

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