Transcript 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/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
RBC:FFP
1:1
1:1
RBC:FFP:PLT
RBC:FFP:PLT
1:1:1
1:1:1
Therapeutic goals
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•
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Hemoglobin>8gr/dl
Platelet count>75,000
PT, aPTT<1.5× mean control
Fibrinogen> 1gr/l
PR
EV
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O
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H
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MI
A
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CI
D
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MANAGEMENT of MASSIVE TRANSFUSION (MMT) for TRAUMA
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
Pre-hospital MMT alert:
•Systolic BP < 90
•Poor response to initial
fluid resuscitation
•Suspected active
haemorrhage
MMT ACTIVATION
For Trauma
(Trauma Team leader must declare MMT
Activation to blood bank ,WHH Bleep
no:8662)
If so activate MMT (match 3 of the ocriteria)
HAEMOSTASIS
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 xmatch at different time if possible)
Co-ordinate Porter urgently to standby for Collection
of MMT pack one
THERAPY TARGET end point:
HAEMORRHAGE CONTROL:
Surgery
Stabilize fractures
Pelvic brace
PREVENT HYPOTHERMIA
HAEMOSTATIC DRUGS:
Consider the following if bleeding persist
despite surgical interventions:
Activated factor VII
Beriplex (consider when patient who is on anticoagulant)
Antifibrinolitic agents
Please discuss any of these therapeutic
measures with Haematologist on call)
MMT PACK 1
4 x O –ve RBC ( female) or O+ve(Male)
4 x AB FFP
(or Group specific if possible)
RE-ASSESSMENT
ABCDE
If haemorrhage continue
Activate MMT PACK 2
Please, specify location of
patient
Fail to
reach
targets
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
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
Notify blood bank
MMT PACK 2
4 X RBC
4 X FFP
1 X ATD Platelets
When MMT stops
Return any unused products
Once administered check:
FBC, Clotting, fibrinogen and ABG
Resume standard ordering practices