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Definition of Massive Transfusion
•Replacement of a blood volume equivalent within 24hr
•Transfusion>10 unit within 24 hr
•Transfusion > 4 units in 1 hr
•Replacement of 50% of blood volume in 3hrs
•A rate of loss >150ml/hr
• hemodynamic stability• tissue oxygenation
packed red blood cells
• Each unit of (RBCs) contains approximately 200 mL of red cells
• in an adult, will raise the hematocrit by roughly 3 to 4 percentage points unless there is continued bleeding.
Dilutional coagulopathy
• happens with 5-10 or more RBC u.
platelet
• <50,000 with active bleeding and surgery, • (1 pack/10kg)( every unit of 50cc, increases
platelet up to 5000/ml), • no need for ABO compatibility but D Ag must
be compatible. • Each platelet concentrate also provides
around 50ml of fresh plasma.
Fresh Frozen Plasma• PT>16" or PTT>60”
• fibrinogen level is under 100 mg/dl;
• ( ABO matched)10-15 ml/kg . (250 cc/unit)
• needs 30 minute for defreezing.
Cryoprecipitate
• ( ABO matched) (1-1.5 packs/10kg)
• Hemophilia A, Von Willebrand, fibrinogen levels < 0.8g/l or decreased factor XIII
• 15cc/unit. 10u cryo (2 pack) results in fibrinogen>1gr/L
Recombinant FactorVIIα
• 90micgr/kg• Contrandicated: Plt<50000 Fibrinogen<1gr/L Abnormal PT Ph<7.2 BT<35
RBC:FFP
1:1RBC:FFP:PLT
1:1:1
RBC:FFP1:1
RBC:FFP:PLT1:1:1
Therapeutic goals
• Hemoglobin>8gr/dl• Platelet count>75,000• PT, aPTT<1.5× mean control• Fibrinogen> 1gr/l
Once administered check:FBC, Clotting, fibrinogen and ABG
RE-ASSESSMENTABCDE
If haemorrhage continue
Activate MMT PACK 2Please, specify location of
patient
MMT PACK 2
HAEMOSTASIS
HAEMORRHAGE CONTROL:SurgeryStabilize fracturesPelvic brace
PREVENT HYPOTHERMIA
HAEMOSTATIC DRUGS:Consider the following if bleeding persist despite surgical interventions:Activated factor VII Beriplex (consider when patient who is on anti-coagulant) Antifibrinolitic agentsPlease discuss any of these therapeutic measures with Haematologist on call)
INTRA-OPERATIVE CELL SALVAGE:Transfuse 1 x FFP every 250 ml of bloodTransfuse 1 x ATD platelets every 1000 ml of blood
2 x packs of Cryoprecipitate if Fibrinogen is < 1.0 g/l
Fail to reach targets
MANAGEMENT of MASSIVE TRANSFUSION (MMT) for TRAUMA
4 X RBC4 X FFP 1 X ATD Platelets
MMT ACTIVATION For Trauma
PATIENT ARRIVALTake bloods (FBC, U&E, Clotting, fibrinogen and X-match and ABG)Send pink bottle with X-match form to blood bank urgently ( please obtain 2 samples for x-match at different time if possible)
MMT PACK 1 4 x O –ve RBC ( female) or O+ve(Male) 4 x AB FFP
(or Group specific if possible)
THERAPY TARGET end point:
Hb: 8-10 g/dlPlatelets > 100PT&APTT (INR)< 1.5Fibrinogen > 1.0 g/lCa²⁺ > 1 mmol/lpH: 7.35-7.45BE: ± 2Tª > 36 °C
Pre-hospital MMT alert:
•Systolic BP < 90•Poor response to initial fluid resuscitation•Suspected active haemorrhageIf so activate MMT (match 3 of the ocriteria)
Hospital MMT alert confirmation(patient requiring urgent transfusion)
- SBP < 90- HR > 100- Ph < 7.35- BE < - 2- Obvious signs of uncontrollable active bleeding- Poor responder to fluid resuscitation(Trauma Team leader must declare MMT Activation to blood bank ,WHH Bleep no:8662)
Co-ordinate Porter urgently to standby for Collection of MMT pack one
When MMT stopsNotify blood bank Return any unused products Resume standard ordering practices
PREVENT
HYPOTHERMI A
AC I DOS I S
COAGULOPATHY