Hemostasis in Massively Transfused Trauma Patients

Abstract

To determine whether administration of stored, modified whole blood induced a primary hemostasis disorder evidenced by generalized microvascular oozing, 27 patients requiring massive transfusions were studied. Platelet counts fell in proportion to the number of units of blood transfused. The levels of factors V and VIII correlated poorly with blood units transfused, 85% of total variation in the levels being due to influences other than transfused blood. Levels of all other clotting factors were unrelated to the number of units of blood given. Eight patients developed abnormal bleeding. The cause appeared to be dilutional thrombocytopenia in 5 patients and DIC [disseminated intravascular coagulation] in 3. In 6 of 8, bleeding was controlled with platelet concentrates alone. Two patients were also given cryoprecipitate. The most useful laboratory test for predicting abnormal bleeding was platelet count. Fibrinogen levels should be followed as an aid in diagnosis of DIC. BT [bleeding time], PT [prothrombin time] and PTT [partial thromboplastin time] were not helpful in assessing bleeding unless they were greater than 1.5 times the control value. Any patient receiving massive transfusions who develops diffuse microvascular bleeding should be given platelet concentrates. Platelet counts as high as 100,000 may be required to control bleeding from surgical wounds. It is not necessary to supplement transfusion of stored, modified whole blood with fresh blood or fresh frozen plasma.