Resumo

VISSER, Adele et al. Blood product utilisation during massive transfusions: audit and review of the literature. SA orthop. j. [online]. 2011, vol.10, n.4, pp.25-29. ISSN 2309-8309.

Acute exsanguination is the leading cause of mortality in trauma patients.^1-3 Massive blood loss potentially results in the development of the 'lethal triad', comprising hypothermia, acidosis and coagulopathy.⁴ Without prompt intervention, including the appropriate administration of blood and blood products, the majority of these patients will demise within 6 hours.^2,4,5 Utilisation of blood and blood products in this setting is considered a lifesaving intervention. A massive transfusion can be defined as the 1) the infusion of five units or more of packed red cell concentrate (RCC) within 4 hours;⁶ 2) infusion of more than ten units RCC within the first 24 hours;^7-15 or 3) infusion of six or more units RCC within 12 hours.^16-18 Irrespective of the formal definition, it has become evident that patients requiring six to nine units of RCC within a 24-hour period have a 2.5 times higher mortality. This mortality risk was significantly higher in patients requiring massive transfusion, than compared to patient groups requiring transfusion of less than six units of RCC.¹⁹ Despite controversy with regard to the definition, the aim of these definitions remains the same: early identification of patients with life-threatening bleeds, to ensure proper resuscitation and prevention of complications associated with resuscitation.⁶ The use of fixed ratios of infused blood products in massive transfusion remains controversial as authors fail to reach consensus on appropriate ratios. These ratios vary from a 1:1:1 ratio for RCC:fresh frozen plasma (FFP):platelets^7,12,20-24 to a 6:4:1 ratio.^{25,2 6} Despite this lack in consensus, it is evident that the practice of fixed ratio transfusions^27,28 in the form of a consistent protocol^{25,2 9} has led to a significant reduction in mortality^10,30 from in excess of 90%³¹ to between 30 and 70%,³² although some authors refute these findings.^13,17 The aim of this study was to determine local practices with regard to transfusion of blood and blood products in patients undergoing massive transfusion.

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