Massive transfusion and coagulopathy: pathophysiology and implications for clinical management

被引:147
作者
Hardy, JF
de Moerloose, P
Samama, M
机构
[1] CHUM, Notre Dame Hosp, Dept Anesthesiol, Montreal, PQ H2L 4M1, Canada
[2] Univ Hosp Geneva, Hemostasis Unit, Geneva, Switzerland
[3] Hop Avicenne, Dept Anesthesie Reanimat, F-93009 Bobigny, France
来源
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE | 2004年 / 51卷 / 04期
关键词
D O I
10.1007/BF03018233
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Purpose: To review the pathophysiology of coagulopathy in massively transfused, adult and previously hemostatically competent patients in both elective surgical and trauma settings, and to recommend the most appropriate treatment strategies. Methods: Medline was searched for articles on "massive transfusion," "transfusion," "trauma," "surgery," "coagulopathy" and "hemostatic defects." A group of experts reviewed the findings. Principal findings: Coagulopathy will result from hemodilution, hypothermia, the use of fractionated blood products and disseminated intravascular coagulation. The clinical significance of the effects of hydroxyethyl starch solutions on hemostasis remains unclear. Maintaining a normal body temperature is a first-line, effective strategy to improve hemostasis during massive transfusion. Red cells play an important role in coagulation and hematocrits higher than 30% may be required to sustain hemostasis. In elective surgery patients, a decrease in fibrinogen concentration is observed initially while thrombocytopenia is a late occurrence. In trauma patients, tissue trauma, shock, tissue anoxia and hypothermia contribute to the development of disseminated intravascular coagulation and microvascular bleeding. The use of platelets and/or fresh frozen plasma should depend on clinical judgment as well as the results of coagulation testing and should be used mainly to treat a clinical coagulopathy. Conclusions: Coagulopathy associated with massive transfusion remains an important clinical problem. It is an intricate, multifactorial and multicellular event. Treatment strategies include the maintenance of adequate tissue perfusion, the correction of hypothermia and anemia, and the use of hemostatic blood products to correct microvascular bleeding.
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收藏
页码:293 / 310
页数:18
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