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Massive Blood Transfusion

You are here : Home/ Blood Bank Zone/ Blood Transfusion in Clinical Practice/ 6. Massive Blood Transfusion

6. Massive Blood Transfusion

Massive blood transfusion Is defined as replacement of the patient’s total blood volume by stored homologous blood in less than 24 hours. Clinical conditions in which massive transfusion is required include:

a Haemorrhagic shock (Acute blood loss > 20% of blood volume In adults & >10-15% in children and pregnancy)
- Obstetric patients
- Severe trauma
b. Exchange transfusion
c. Cardiopulmonary bypass
Management of these critically ill patients requires a close link between the treating physicians and the blood transfusion centre.

Blood volume

Management of shock due to hypotension or acute blood loss is the most important factor. Prior to availability of whole blood, hypotension should be promptly treated with
* Isotonic saline
* Ringer Lactate
* Synthetic colloids e.g. gelatin, hydroxyethyl starch, to make upto 40% blood volume.

As soon as blood loss and fluid replacement reaches 40% of blood volume, replacement of red cells is required.

It is preferrable to use whole blqpd after 3-4 red cell concentrates are transfused, to provide plasma proteins required for maintenance of colloid osmotic pressure.

Blood transfusion

The blood transfusion laboratory should be informed of the need for massive transfusion in a patient and the urgency of transfusion.

1. If time permits, perform
* Blood grouping
* Antibody screening
* Compatibility testing

2. In urgent cases, perform
* ABO & Rh(D) typing
* Immediate spin crossmatch
* LISS-AHG crossmatch

3. In extreme emergency
* Supply group ‘0’ red cells
* Follow by ABO & Rh (D) group-specific blood
* Rh(D) negative women of child bearing age - Supply Rh(D) negative blood.
(This practice should only be abandoned when Rh(D) negative blood is not available and the patients life is in danger).

Usually whole blood less than 5 days old is more useful.. The massively bleeding patient requires volume, oxygen carrying capacity and haemostatic support, and all these are best provided by fresh whole blood.

Minimum laboratory investigations in patients with acute hypovolaemic shock are:
On the basis of the laboratory findings, the transfusion strategy is formulated to correct any haemostatic defects.

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