Affordable Access

Publisher Website

Optimal use of blood in trauma patients

Authors
Journal
Biologicals
1045-1056
Publisher
Elsevier
Publication Date
Volume
38
Issue
1
Identifiers
DOI: 10.1016/j.biologicals.2009.10.007
Keywords
  • Hemorrhage
  • Transfusion
  • Coagulopathy
  • Shock
  • Trauma
Disciplines
  • Medicine

Abstract

Abstract Injury is rapidly becoming the leading cause of death worldwide, and uncontrolled hemorrhage is the leading cause of potentially preventable death. In addition to crystalloid and/or colloid based resuscitation, severely injured trauma patients are routinely transfused RBCs, plasma, platelets, and in some centers either cryoprecipitate or fibrinogen concentrates or whole blood. Optimal timing and quantity of these products in the treatment of hypothermic, coagulopathic and acidotic trauma patients is unclear. The immediate availability of these components is important, as most hemorrhagic deaths occur within the first 3–6 h of patient arrival. While there are strongly held opinions and longstanding traditions in their use, there are little data within which to logically guide resuscitation therapy. Many current recommendations are based on euvolemic elective surgery patients and incorporate laboratory data parameters not widely available in the first few minutes after patient arrival. Finally, blood components themselves have evolved over the last 30 years, with great attention paid to product safety and inventory management, yet there are surprisingly limited clinical outcome data describing the long term effects of these changes, or how the components have improved clinical outcomes compared to whole blood therapy. When focused on survival of the rapidly bleeding trauma patient, it is unclear if current component therapy is equivalent to whole blood transfusion. In fact data from the current war in Iraq and Afghanistan suggest otherwise. All of these factors have contributed to the current situation, whereby blood component therapy is highly variable and not driven by long term patient outcomes. This review will address the issues raised above and describe recent trauma patient outcome data utilizing predetermined plasma:platelet:RBC transfusion ratios and an ongoing prospective observational trauma transfusion study.

There are no comments yet on this publication. Be the first to share your thoughts.

Statistics

Seen <100 times
0 Comments

More articles like this

Optimal use of blood products in severely injured...

on Hematology / the Education Pro... 2010

Optimal use of blood and blood products.

on The Medical clinics of North A... January 1963
More articles like this..