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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.

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Presentation on theme: "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."— Presentation transcript:

1 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 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 3 The administration of: –platelet concentrates –cryoprecipitate –and fresh frozen plasma can prevent this complication to patients receiving massive transfusions

4 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 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 O 2 resulting in poor O 2 delivery to tissues Thus, during massive transfusion, a commercial blood warmer should be used to warm blood toward body temperature during infusion.

6 6 2,3 DPG Deficiency During storage erythrocytes concentration of 2,3-DPG falls This increases affinity of Hb to O 2 → less efficient in delivery of O 2 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 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 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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