simi
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A multiple trauma pt is recieving massive blood transfusions as the surgeons r attempting to repair many intra abdominal injuries .It is then noted that blood is oozing from all dissected raw surfaces as well as from IV line sites.His core temp is normal
explanation- Signs of coagulopathy in this setting requires a shotgun approach to treatment .Empiric administration of both fresh frozen plasma and platelet packs is recommended .
while explaining this vignette ,the lecturer in surgery lecture says that when a pt gets 10 to 12 lts of blood a coagulopathy has to ensue....
can anyone explain the mechanism of development of coagulopathy plz?
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| farnsworth
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short explanation:
if you infuse PRBCs and cristalloids in a patient w/ multiple traumas, a so-called dilution coagulopathy develops. It is reasonable to start FFP transfusion when 6 or more PRBCs have been transfused. If more than 1.5-2x the intravascular fluid volume (males: ca 75mL/kg, women: ca 68mL/kg -> 70mL/kg is good estimation) are 'exchanged' (transfusion + cristalloids/colloids), you should think about replacing lost platelets.
In this case: the patient lost 12L of fluid, in a 80kg patient this corresponds to 2x intravascular fluid (80kg x 70mL/kg = 5.6L). So FFP transfusion should have been initiated long before. Next step would be PLT transfusion (when the patient is bleeding from ruptured vessels, this would not stop bleeding, but the transfused platelets will 'escape' from the circulation via the bleeding sites, so some anesthesiologist tend to 'delay' transfusion of PLT, unless the patient is bleeding profusely). If the patient has blunt traumatic injuries (e. g. MVA) and the bleeding is hard to control: rFVIIa (NovoSeven) 4.5kIE/kg, this can be repeated every 4hrs (or q2hrs in excessively bleeding patients).
A coagulopathy does not necessarily ensue, if the patient is treated adequately (apprx 2 years ago one of our patients received 150PRBCs, 120 FFPs and 30 PLTs, tons of rFVIIa, and the patient recovered extremely well).
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| simi
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thanks farnsworth
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