Transfusion of blood and its components has an important role in management of the trauma patient. As transfusion is not without risks, decisions must weigh the benefits of potential improvement in outcome versus the associated risks.
Blood and blood products have ability to replace red blood cells and improve oxygen transport capacity, and to correct coagulation defects.
Complications of blood product transfusion include the risk of febrile, allergic, or hemolytic transfusion reactions, infectious disease transmission, coagulation defects and bleeding, and immunosuppression.
Red Blood Cell Transfusion
Packed red blood cells are used to restore red cell mass and oxygen-carrying capacity. The decision to use red blood cell transfusion in the trauma patient should take into consideration the potential for continued hemorrhage and the complications of inadequate tissue oxygen delivery .
A blood needs to crossmatched before. This done by mixing drops of recipient blood and donor blood on a slide and then look for agglutination, a phenomenon where red cell clump. There are many major and minor factors in blood that should be crossmatched before blood can be declared safe.
Testing all these factors require up to 45 minutes. This much delay may not be acceptable in case of severe blood loss. In such cases type O-negative red blood cells can be used for the unstable patient with severe, ongoing blood loss not responsive to nonblood therapy.
Type-specific/uncrossmatched or partially crossmatched blood requires approximately 5 to 10 minutes before availability and is safe for use in patients requiring the ongoing transfusion of fluids and blood to maintain stability
Autotransfusion
Autotransfusion involves the collection of shed blood from wounds, body cavities, or drains for reinfusion . Blood is collected from body cavities, such as the thorax, using a suction device with citrate anticoagulant and directly reinfused into the trauma patient through a macroaggregate filter.
The advantages of autotransfusion systems include the relatively immediate availability of blood corresponding to the amount lost, the elimination of disease transmission because the patient receives his or her own blood, and the elimination of adverse reactions associated with transfusion Disadvantages include coagulopathy from excessive anticoagulant in the collected blood and disseminated intravascular coagulopathy and contamination by abdominal contents
Massive Transfusion
Occasionally, severe and ongoing hemorrhage necessitates the massive transfusion of blood to prevent shock and death. Massive transfusion is defined as the transfusion of at least one complete blood volume (normal is 5-6 litres) in a 24-hour period or the acute administration of more than half the patient’s estimated blood volume per hour.
Platelet Transfusion
Transfusion of platelets is indicated in the trauma patient with evidence of microvascular surgical bleeding and a severly decreased platlet count.
Fresh Frozen Plasma
Fresh frozen plasma provides both stable and labile plasma coagulation factors . Indications include the correction of microvascular bleeding with a documented coagulopathy, and for known coagulation factor deficiencies.
Cryoprecipitate
Cryoprecipitate is administered for evidence of microvascular bleeding in massively transfused patients with low fibrinogen levels.
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