CHEMOTHERAPY ANALYSIS IN MASSIVE TRANSFUSION SYNDROME

Abstract

INTRODUCTION: Massive transfusion is defined as blood transfusion in quantities equal to or greater than the estimated patients' blood volume over a relatively short period of time (3-4 hours). The study was aimed at analyzing the application of chemotherapy in treatment of patients with acute massive bleeding and evaluating the results of hemostasis and platelet counts screening tests in the patients receiving massive transfusions. MATERIAL AND METHODS: Attempts were made to fully compensate hemostatic factors in 24 patients (14 male and 10 female, aged 23 to 76 years) with acute massive and uncontrolled surgical bleeding (polytrauma, abdominal aortic aneurysm, digestive tract bleeding as a result of a farina overdose, mortus fetus) over the five-year period, wherein a circulating patients' blood volume was compensated over a relatively short period of time. First the surgical bleeding was stopped. The objective of chemotherapy was the combined use of resuspended red blood cells, fresh frozen plasma, cryoprecipitates and the platelet concentrate in order to maintain the patients' normal circulating blood volume and blood pressure (systolic blood pressure ≥ 100 mmHg) with hemoglobin value higher than 100 g/l and the hematocrit above 0.30 l/l. RESULTS: Transfusion treatment of 24 patients with acute bleeding consisted of an average of 16 to 18 units of resuspended red blood cells (ranging from 4,880 ml to 5,220 ml); fresh frozen plasma (980 ml to 1,220 ml); cryoprecipitates (an average of 10 to 15 units i.e. 500-750 ml) and concentrated platelets (approximately an average of 8 to 12 units i.e. 240 to 360 ml). CONCLUSION: In our study we have confirmed the pathophysiological mechanism shown in the available medical literature that after transfusion of a large red blood cell concentrate volume, dilutional coagulopathy develops, caused by a sharp drop in platelet count and the significantly reduced activity of unstable coagulation factors in the patient's circulation.