ABSTRACT
Massive transfusion has traditionally been defined as the replacement o f one blood volume in a 24-hour period, accomplished by transfusion o f 10 U RBCs and some combination of crystalloids and, hopefully, plasma. Hardy (Vox sanguinis article) offers alternative criteria o f 4 or more R BCS in one hour with additional units anticipated, or 50% blood volume replacement in a three-hour span. These definitions make intuitive sense; one hardly needs to wait until the tenth unit o f red cells has been transfused to shift into the massive transfusion mode, nor should one. This section outlines the approach to executing the high-volume transfusion, but stops short o f treating the patient with obvious disseminated intravascular coagulopathy. This phenomenon, which may occur secondary to deterioration o f a patient receiving a massive transfusion during elective surgery, following severe postpartum hemorrhage, subsequent to GI or vascular bleeds, or due to trauma, is covered in section 5.2. The guiding principlefor the uncomplicated massive transfusion then, is to take a systematic approach to these three elements: replenish RBCs to support perfusion; prevent and correct incipient coagulopathy with FFP, platelets and cryoprecipitate; and manage the physiologic derangements o f the large-volume transfusion.
