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Complications of Massive Transfusion

2010; Elsevier BV; Volume: 137; Issue: 1 Linguagem: Inglês

10.1378/chest.09-0252

1931-3543

Kristen C. Sihler, Lena M. Napolitano,

Sepsis Diagnosis and Treatment

Massive transfusion (MT) is a lifesaving treatment of hemorrhagic shock, but can be associated with significant complications. The lethal triad of acidosis, hypothermia, and coagulopathy associated with MT is associated with a high mortality rate. Other complications include hypothermia, acid/base derangements, electrolyte abnormalities (hypocalcemia, hypomagnesemia, hypokalemia, hyperkalemia), citrate toxicity, and transfusion-associated acute lung injury. Blood transfusion in trauma, surgery, and critical care has been identified as an independent predictor of multiple organ failure, systemic inflammatory response syndrome, increased infection, and increased mortality in multiple studies. Once definitive control of hemorrhage has been established, a restrictive approach to blood transfusion should be implemented to minimize further complications. Massive transfusion (MT) is a lifesaving treatment of hemorrhagic shock, but can be associated with significant complications. The lethal triad of acidosis, hypothermia, and coagulopathy associated with MT is associated with a high mortality rate. Other complications include hypothermia, acid/base derangements, electrolyte abnormalities (hypocalcemia, hypomagnesemia, hypokalemia, hyperkalemia), citrate toxicity, and transfusion-associated acute lung injury. Blood transfusion in trauma, surgery, and critical care has been identified as an independent predictor of multiple organ failure, systemic inflammatory response syndrome, increased infection, and increased mortality in multiple studies. Once definitive control of hemorrhage has been established, a restrictive approach to blood transfusion should be implemented to minimize further complications. Erratum: Chest. 2010;137(1):209-220CHESTVol. 137Issue 3PreviewIn the January 2010 issue, the article “Complications of Massive Transfusion” (Chest. 2010;137(1):209-220) by Sihler and Napolitano contained an error on page 212. The term “hyperperfusion” in the first full paragraph is incorrect. The sentence should instead read (replacement term shown in italics): However, if the primary derangement in early coagulopathy is related to hypoperfusion resulting in anticoagulation from activation of the thrombomodulin-protein C pathway, augmentation of thrombin generation in the presence of hypoperfusion may cause further activation of anticoagulant and fibrinolytic pathways. Full-Text PDF