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Transfusion strategy in multiple trauma patients


Theusinger, Oliver M; Stein, Philipp; Spahn, Donat R (2014). Transfusion strategy in multiple trauma patients. Current Opinion in Critical Care, 20(6):646-655.

Abstract

PURPOSE OF REVIEW To point out the tolerance of anemia, the possible use of alternatives to allogeneic blood products as well as the pathophysiological effects of transfusions in the context of multiple trauma patients. RECENT FINDINGS Restrictive transfusion triggers are beneficial for patient outcome in trauma.The actual European Trauma Treatment Guidelines suggest the use of point-of-care devices, the use of transfusion algorithms and factor concentrates to control coagulopathy. The use of high ratios of plasma to red blood cells to improve survival has been shown to suffer from a time-dependent survival bias. In massive bleeding, factor-based treatment of coagulopathy is feasible and preferable to plasma transfusion, if available. In nonmassive bleeding, allogeneic transfusion of blood products increases the appearance of serious adverse events and mortality and should be avoided unless clearly indicated. SUMMARY Transfusion in trauma has to be an individual decision for a specific patient, not for a specific laboratory value. Transfusion management must aim at reducing or even avoiding the use of allogeneic blood products. This may lead to a new gold standard with cost reduction and amelioration of outcome of major trauma patients.

Abstract

PURPOSE OF REVIEW To point out the tolerance of anemia, the possible use of alternatives to allogeneic blood products as well as the pathophysiological effects of transfusions in the context of multiple trauma patients. RECENT FINDINGS Restrictive transfusion triggers are beneficial for patient outcome in trauma.The actual European Trauma Treatment Guidelines suggest the use of point-of-care devices, the use of transfusion algorithms and factor concentrates to control coagulopathy. The use of high ratios of plasma to red blood cells to improve survival has been shown to suffer from a time-dependent survival bias. In massive bleeding, factor-based treatment of coagulopathy is feasible and preferable to plasma transfusion, if available. In nonmassive bleeding, allogeneic transfusion of blood products increases the appearance of serious adverse events and mortality and should be avoided unless clearly indicated. SUMMARY Transfusion in trauma has to be an individual decision for a specific patient, not for a specific laboratory value. Transfusion management must aim at reducing or even avoiding the use of allogeneic blood products. This may lead to a new gold standard with cost reduction and amelioration of outcome of major trauma patients.

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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Institute of Anesthesiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:December 2014
Deposited On:21 Nov 2014 12:07
Last Modified:05 Apr 2016 18:32
Publisher:Lippincott Williams & Wilkins
ISSN:1070-5295
Publisher DOI:https://doi.org/10.1097/MCC.0000000000000152
PubMed ID:25314239

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