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[Indications of blood components and outcome of transfusion practices in hemorrhage of multiple trauma].

Bleeding occurring in a patient with multiple trauma has an unpredictable evolution; blood losses are often very important and their origins mostly unclear. These problems should not prevent the use of a strategy for optimal use of blood components. Indications for packed red cells, fresh frozen plasma, platelets and coagulation factors are discussed. Indications for packed red cells are discussed in relation with the patient's conditions (myocardial, cerebral and pulmonary functions) and the clinical status. If the patient is shocked, transfusion must be ordered to maintain a haemoglobin level greater than 10 g.100 ml-1. Considering its cost, the use of albumin must and can be reduced when fluid replacement is realized with long lasting colloids, like starch. Warming of transfused blood is necessary, especially if acceleration disposals are used to prevent or minimize hypothermia. Use of portable monitors for haemoglobin and coagulation parameters is recommended.