Managing Massive Transfusions in diverse Patient Populations in a Non-Metropolitan Area

Abstract

AABB - organization formerly known as the American Association of Blood Banks), RBCs - packed red blood cells, APTT - activated partial thromboplastin time, FDA - Food and Drug Administration, FFP - fresh frozen plasma, TRALI - transfusion acquired acute lung injury, TACO - transfusion associated circulatory overload, TXA - Tranexamic acid, rVIIa - Recombinant factor VIIa, PCCs - Prothrombin Complex Concentrates, PPH - postpartum hemorrhage INDEX TERMS: Hypothermia slows down the body's ability to maintain coagulation, affects platelet activation, and leads to cardiac complications.5 The patient may also already be in a hypothermic state due to shock, blood loss from the trauma, and exposure to the elements. The patient's coagulation should be monitored with fibrinogen levels, a pro-time (PT), activated partial prothrombin time (APTT), and platelet count.7 Thromboelastography (TEG) is not usually available in most non-metropolitan areas, but is a valuable coagulation monitoring assay if available. The earlier the laboratory values for coagulation are tested and evaluated, the sooner the correct product ratios can be obtained for a better patient outcome.6 When an obstetrical patient begins receiving blood components, it is important to assess their fibrinogen level early in a suspected PPH and provide cryoprecipitate, TXA, or both, if clinically indicated.