Some important points in bulk blood transfusion

The article was written by Specialist Doctor II Pham Tien Ngoc - Emergency Doctor, Emergency Department - Vinmec Central Park International Hospital

Bulk transfusion is the transfusion of a large volume of blood over a short period of time, in a patient with acute, massive, ongoing blood loss. The issue of resuscitation is extremely important, it is necessary to coordinate many specialties, including hematology specialists, which play an important role, in order to optimize resuscitation and avoid complications due to resuscitation problems. , bulk blood transfusion.

Massive bleeding causes shock (due to hypovolemia, decreased cardiac output) resulting in decreased oxygen delivery to tissues. Progressive shock induces a systemic inflammatory response and acidosis further impairs tissue oxygenation.

1.1 Adults Transfusion of blood > 10 units of erythrocyte sedimentation, within 24 hours. Transfuse ≥ 4 units of erythrocyte sedimentation within 1 hour and other blood products should be continued. Replace > 50% of blood volume within 3 hours. Blood transfusion is required, when blood loss > 150ml/min. >>> Purpose and Indications of Bulk Transfusion
1.2 Children Because of the variability of age and weight in determining total blood volume in children, the definition of bulk transfusion in children as follows:
Transfuse 100% whole blood volume within 24 hours Replace 50% of blood volume within 3 hours Replace 10% blood volume/minute Estimated total blood volume in children (ml/kg):

Transfusion of ≥ 4 erythrocyte sedimentation units ± hemodynamic instability ± predicts hemodynamic instability. Severe trauma (chest + abdomen), multiple trauma, pelvic fracture, major vascular injury,... Obstetric bleeding (postpartum haemorrhage), severe gastrointestinal bleeding (eg rupture of varicose veins) oesophageal vessels,.....) 2.1 Resuscitation Objectives: optimize blood oxygenation, cardiac output, tissue and organ perfusion, metabolic status, electrolytes,...
Necessary goals achieved: temperature >35oC, pH >7.2, residual alkalinity <-6, lactate <4mmol/L, Ca2+> 1.1 mmol/L, platelets >50,000, PT/APTT <1.5 normal values , INR <1.5, fibrinogen > 1g/dl.
Procedures for red alarms are activated, pressure is applied, garo, analgesia,... Evaluation of surgical intervention or urgent DSA. Avoid hypothermia (using equipment for warming, heating, ...), avoid excessive crystalloid infusion, need to adhere to resuscitation transfusion and blood products according to the ratio and amount of blood loss. Use cell rescue strategies when appropriate. Consider rFVIIa (not recommended for trauma patients). Notify the hematologist, prepare necessary test components, prepare tests that will be repeated many times,.... Monitor blood count, TQ, TCK, fibrinogen, blood calcium, gas arterial blood every 60 minutes.

In 2015, Murthy et al reviewed recent data on resuscitation in patients with uncontrolled massive blood loss, reaching the following conclusion: A large amount of data is available to support the use of 1:1:1 ratio (Random 1 Red blood cells: 1 Fresh frozen plasma: 1 Platelet) in the resuscitation of patients with severe trauma, shock, and uncontrolled bleeding. Rapid tests: complete blood count, TQ, TCK, blood group, fibrinogen, INR. Red alert coordinated with biochemistry and hematology department activated "Bulk transfusion procedure" 4 units of erythrocyte sedimentation + 2 fresh frozen plasma ± 1 unit of platelet concentrate ± cryoprecipitate if fibrinogen < 1g/l ± Tranexamic acid for trauma patients Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with a team of leading medical professionals, modern equipment and technology. . The hospital provides comprehensive and professional medical examination, consultation and treatment services, with a civilized, polite, safe and sterile medical examination and treatment space.