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Massive Blood Transfusion

Feb 26, 2016

Trauma and other issues that lead to the need for a massive blood transfusion are urgent matters. The reason that large quantities of blood are given is because the body has lost too much blood to function properly. It always happens in surgeries, childbirth, trauma due to accidents, and bleeding in the stomach.

What Is a Massive Blood Transfusion?

Patients needing a massive blood transfusion require blood replacement over 50% of their blood volume in a 4-hour time period, or their total blood volume replaced in a 24-hour time period. This equates to about 70ml of blood per kg of body weight. In children, this is about 40ml of blood per kg of body weight.

A blood transfusion is also considered “massive” if 10 or more units of packed red cells are given in a 24-hour period. Things that need to be looked at quickly are: the patient’s blood type, reason for blood loss, electrolyte levels, and the heart’s ability to pump blood to the tissues. Inadequate blood to the tissues and organs can cause them to rapidly fail. These types of transfusions are usually done in response to conditions that cause a massive hemorrhage or bleeding in the body, which we will discuss below.

When a Massive Blood Transfusion Is Needed?

Massive blood loss can be caused by the examples below. Any of these conditions are serious and large amounts of immediate blood replacement are necessary for survival. These include:

  • Car accidents
  • Stabbing wounds
  • Gun Shot wounds
  • Surgery
  • Childbirth
  • Stomach ulcers
  • Rupture of blood vessels
  • Heavy menstruation
  • Cancer/Leukemia
  • Liver disease

The risk for severe blood loss depends on the person’s overall health status, age, body weight, and cardiovascular status. And compare with men, women tend to be at higher risk because of the smaller amount of blood in the body.

Risks and Complications of Massive Blood Transfusion

There are a few risks and complications of having a massive blood transfusion. While rare, they do happen. These are:

1. Acute Hemolytic Transfusion Reaction

While this is rare, it happens to around 20 people receiving transfusions every year. Blood can be mislabeled or not checked enough for compatibility and the reaction happens within the first hour after the transfusion. Symptoms includeanxiety, fever, chills, and back pain. It can also causelow blood pressure, cold skin, rapid pulse, and jaundice. It can lead to kidney failure if left untreated. Treatments like stopping the transfusion, giving diuretics and increasing IV fluids can ease the symptoms.

2. Allergic Reactions to Donor Blood

Substances or antibodies in donor blood can cause an allergic reaction in the individual receiving the blood transfusion. They are not always serious and cause symptoms of a mild allergic reaction including itching, rash, headache, and sometimes fever. In more serious reactions, shortness of breath and anaphylactic shock can happen but these are rare. Treatment includes: antihistamines, steroids, and possibly even epinephrine.

3. Increased Fluid Volume

Fluid volume overload can happen often with rapid infusion of any fluids or blood products. This can cause fluid in the lungs and heart failure. A massive blood transfusion still needs to be administered slow enough to prevent this from occurring. Treatment like giving a diuretic to help reduce fluid load should be carried out.

4. Hypothermia

If blood products are too cold and not warmed to body temperature, they can cause hypothermia in the body if given too fast. Blood that is too cold will cause the heart to become irritated and hence, can lead to a fatal heart rhythm and cardiac arrest.

5. Infection

Bacterial and viral infections can be transmitted via blood products if they are not thoroughly inspected before transfusion. The patient may catch syphilis, hepatitis, HIV, and cytomegalovirus in this way. In order to prevent them from happening, blood banks should never store blood for longer than 5 days. Malaria can also be transmitted via blood. Any of these infections can be avoided by thorough donor testing, questionnaires about lifestyle, travel and health, along with proper blood bank procedures for testing and storage.

Protocol for Massive Blood Transfusion

When a massive blood transfusion is given, these are the protocols that need to be followed in order to protect the safety of the patient:

1. Replace Lost Fluids

A massive hemorrhage requires quick fluid replacement to prevent organ failure. Packed red blood cells can be given with fluids to replace volume quickly.

2. Draw Blood

Initial laboratory values include:check for blood type and do crossmatch, check for blood clotting factors, complete blood count and chemistry profile. Blood type and crossmatch needs to be verified and noted properly, plus labels printed and verified.

3. Contact the Blood Bank

Call the blood bank as soon as a massive bleeding situation arrives in a trauma bay or surgical issue occurs. Type O blood can be given immediately in very serious situations. Rh negative blood needs to be given to women of childbearing age, pregnant, or in labor. The same type blood needs to be supplied within the first 5 minutes if possible to prevent using too much Type O blood.

4. Monitor Patient’s Condition

While blood is being transfused, the patient needs to be checked with continuous laboratory studies, which include: hemoglobin levels, platelets, clotting (PT and PTT), and fibrinogen.

5. Give Blood Components If Necessary

If the source of bleeding cannot be immediately stopped or surgery needs to be done to stop bleeding, then give the following blood components:

  • Platelets:If the platelet count is less than 50, give a pack of platelets per 10kg of body weight.
  • Cryoprecipitate: This preparation is made from fresh frozen plasma and is a concentrate of clotting factors, and fibrinogen. This helps in emergencies caused by anticoagulant medications, hemophilia, and very large hemorrhages.