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Definition of Massive Transfusion

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/h r. hemodynamic stability tissue oxygenation. packed red blood cells.

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Definition of Massive Transfusion

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  1. 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

  2. hemodynamic stability • tissue oxygenation

  3. 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.

  4. Dilutionalcoagulopathy • happens with 5-10 or more RBC u.

  5. 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.

  6. 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.

  7. 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

  8. Recombinant FactorVIIα • 90micgr/kg • Contrandicated: Plt<50000 Fibrinogen<1gr/L Abnormal PT Ph<7.2 BT<35

  9. RBC:FFP 1:1 RBC:FFP:PLT 1:1:1 RBC:FFP 1:1 RBC:FFP:PLT 1:1:1

  10. Therapeutic goals • Hemoglobin>8gr/dl • Platelet count>75,000 • PT, aPTT<1.5× mean control • Fibrinogen> 1gr/l

  11. MANAGEMENT of MASSIVE TRANSFUSION (MMT) forTRAUMA PREVENT HYPOTHERMI A AC I DOS I S COAGULOPATHY 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 • Pre-hospital MMT alert: • Systolic BP < 90 • Poor response to initial fluid resuscitation • Suspected active haemorrhage • If so activate MMT (match 3 of the ocriteria) MMT ACTIVATION For Trauma PATIENT ARRIVAL Take 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) HAEMOSTASIS THERAPY TARGET end point: Hb: 8-10 g/dl Platelets > 100 PT&APTT (INR)< 1.5 Fibrinogen > 1.0 g/l Ca²⁺ > 1 mmol/l pH: 7.35-7.45 BE: ± 2 Tª > 36 °C MMT PACK 1 4 x O –ve RBC ( female) or O+ve(Male) 4 x AB FFP (or Group specific if possible) HAEMORRHAGECONTROL: Surgery Stabilize fractures Pelvic brace PREVENT HYPOTHERMIA Fail to reach targets RE-ASSESSMENT ABCDE If haemorrhage continue HAEMOSTATIC DRUGS: Consider the following if bleeding persist despite surgical interventions: Activated factor VII Beriplex (consider when patient who is on anti-coagulant) Antifibrinolitic agents Please discuss any of these therapeutic measures with Haematologist on call) Activate MMT PACK 2 Please, specify location of patient 2 x packs of Cryoprecipitate if Fibrinogen is < 1.0 g/l INTRA-OPERATIVE CELL SALVAGE: Transfuse 1 x FFP every 250 ml of blood Transfuse 1 x ATD platelets every 1000 ml of blood MMT PACK 2 Once administered check: FBC, Clotting, fibrinogen and ABG 4 X RBC 4 X FFP 1 X ATD Platelets When MMT stops Notify blood bank Return any unused products Resume standard ordering practices

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