MASSIVE TRANSFUSION

Massive bleeding, and the resultant need for replacement of red blood cells and other blood components, requires emergent action and coordination among many health care providers. The most common complication encountered in massive transfusion (MT) is dilution of platelets, coagulation factors, and red blood cells. The development of disseminated intravascular coagulation is related more to the patient's underlying condition and length of poor tissue perfusion rather than the result of MT itself. Other factors to consider during MT include temperature regulation, electrolyte abnormalities, respiratory complications, and the risk of viral transmission. We present an operational approach to MT in use at the Oregon Health Sciences University in which we advocate a pro-active consultative role of pathologists. We favor the use of frequent monitoring of hematocrit, prothrombin time/partial thromboplastin time, platelet count, and fibrinogen to direct component replacement of specific factor deficiencies.