Blood TransfusionsBlood Transfusions
PRBC
PRBC
PRBC
PRBC
PRBC
2U PRBC Hct %
PRBC
2U PRBC Hct %
3%Hb 1 g/dL
PRBC
K, Na, NH3, Alb, Ab
PRBC
PRBC
PRBC transfusion indications
PRBC
PRBC transfusion indications
Hemorrhagic shock
Active ongoing bleeding
PR increase 20%
BP decrease 20%
Symptomatic anemia
Hb < 7 g/dLHct < 21%
Hb < 9 g/dLHct < 27%in patients with coronary or
cerebrovascular disease
PRBC
PRBC
PRBC
PRBC
Still controversial
Hct higher will raise ScvO2, but tissue O2 delivery(?)
PRBC
Massive PRBC transfusion
PRBC
Massive PRBC transfusion
24
= 70 mL kg70 kg 5000 mL
1 8U PRBC
12 20U PRBC
PRBC
Massive PRBC transfusion
PRBC
Massive PRBC transfusion 1000 mLPRBC + Crystalloid
1000 mL PRBC FFP11
1 pheresis U 12 U platelet concentrates
FFP 25
CBCPTAPTT Fibrinogen
PRBC
Massive transfusion
PRBC
Massive transfusion Hyperkalemia
Hypocalcemia
Acid-base derangements
Dilutional thrombocytopenia ( the most common cause of bleeding
after massive transfusion)
DIC
Impaired O2 delivery (Hb dissociation curve
Hypothermia
Iron overload
FFP
1 U FFP mL
FFP
FFP
1 U FFP = 120 mL
FFP
Coagulation factors
Protein C
Protein S
Antithrombin III
FFP
FFP
FFP
FFP
Massive blood transfusion
Replacement of isolated factor deficiencies
Reversal of warfarin in active bleeding
Plasma exchange in treating TTP
Correct bleeding tendencies with prolonged PT (> 18 s) or
APTT (> 48 s)
FFP
FFP
FFP
FFP
Factor V and VIII are unstable at 4C
4C factor V and VIII
FFP -18C
Frozen plasma (FP)
FP
Frozen plasma (FP)
FP
8
1~6
stored frozen plasmacryo-reduced plsma
Frozen plasma (FP)
FP
Frozen plasma (FP)
FP
Albumin < 2.5 g / dl
Cryoprecipitate
Cryo
Cryoprecipitate
Cryo
15 ml
Fibrinogenfactor Ifactor VIIIXIII von Willebrands
factorvWFfibronectin
/ -181
Cryoprecipitate
Cryo
Cryoprecipitate
Cryo
Hypofibrinogenemia
DIC
A
von Willebrand DDAVP
Platelets
20-24C (agitator) 5
Platelets
Plt concentrate
Platelets
Plt concentrate
Plt < 20,000increased risk of spontaneous bleeding
Before, during, or after surgery or invasive procedure, with Plt
< 50,000
Significant bleeding in the setting of platelet dysfunction,
regardless of Pltcount (e.g. mediastinal bleeding after
cardiopulmonary bypass, uremia)
Platelets
Platelets
Pooled random-donor concentrate (Plt)
30~40 mL
2,500~5,000 /L
Single donor platelets from apheresis (PH) 12U Plt
200 mL
60,000 /L
1. Pelvic fracture massive blood transfusion
2. Warfarin overdose
3. Hypofibrinogenemia
4.
spontaneous bleeding
5. FFP FP FP coagulation factors
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