Management of massive transfusion

Massive transfusion is defined as a transfusion of blood equivalent to the patient's normal blood volume given within 24 h. Severe hemorrhage causes acute hypovolemic shock leading to underperfusion of vital organs and tissues. Mortality increases with the duration and severity of shock. Urgent resuscitation is needed to restore the circulating blood volume and oxygen-carrying capacity of blood and to maintain hemostasis and biochemical balance.

Following a massive transfusion, mortality and morbidity are high; this is mainly due to the underlying condition causing the blood loss rather than the massive transfusion itself. Some conditions predispose to abnormalities of hemostasis. Prolonged hypotension, extensive tissue damage, and obstetric complications can cause disseminated intravascular coagulation (DIC), and established liver or renal disease may impair coagulation and exacerbate metabolic complications associated with massive transfusion.

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