hematology and oncology
Complications of Transfusion
Complications of massive transfusion
Massive transfusion is transfusion of a volume of blood greater than or equal to one blood volume in 24 hours (eg, 10 units in a 70-kg adult). When a patient receives standard resuscitation fluids of packed RBCs (colloid) plus crystalloid (Ringer's lactate or normal saline) in such large volume, the plasma clotting factors and platelets are diluted, causing a coagulopathy (dilutional coagulopathy). This coagulopathy worsens the consumptive coagulopathy due to major trauma itself (ie, as a result of extensive activation of the clotting cascade) and leads to a lethal triad of acidosis, hypothermia, and bleeding. coagulopathy develops, rather than trying to "catch up." Such protocols have been shown to decrease mortality, although the ideal ratios of RBCs, plasma, and platelets are still being developed. One trial showed no significant mortality difference between giving one unit of plasma and one platelet concentrate for each 2 units of RBCs (1:1:2) versus giving one unit of plasma and one platelet concentrate for every 1 unit of RBCs (1:1:1 [ General references ]). Hypothermia due to rapid transfusion of large amounts of cold blood can cause Overview of Arrhythmias or Citrate and potassium toxicities generally are not of concern even in massive transfusion; however, toxicities of both may be amplified in the presence of hypothermia. Patients with liver failure may have difficulty metabolizing citrate. Hypocalcemia can result but rarely necessitates treatment (which is 10 mL of a 10% solution of 