| Global Journal of Hematology and Blood Transfusion (Volume 2 Issue 2) |
Review of Blood Transfusion Strategies among Trauma Patients
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Pages 33 - 42
Sumit Vishwakarma, Garima Aggarwal and Arulselvi Subramanian
DOI: http://dx.doi.org/10.15379/2408-9877.2015.02.02.06
Published: 12 August 2015
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| Abstract |
Introduction: Trauma is the third most common cause of mortality worldwide and leading cause of death in the age group 1 to 44 years. Among those trauma patients, major hemorrhage is responsible for 30 to 40% of mortality, despite the fact that it could be preventable and reversible. The ideal resuscitation strategy for trauma patients remains a topic of ongoing debate. Transfusion services stress trauma centers with demands for strict accountability for individual blood component units and adherence to indications in a clinical field where research has been difficult and guidance opinion-based. New data suggest that the most severely injured patients arrive at the trauma center already coagulopathic and these patients benefit from prompt specific and corrective treatment. At present, no consensus has been reached on ideal fluid for early resuscitation and on the threshold for blood product transfusions. This review article provides a brief overview of recent advances in trauma induced hematological complications, role of pathologist in managing them and subsequent complicating issues. Thereby, covering the widest possible body of literature.
Aims and objectives: In this review we address ongoing resuscitation strategies along with potential complications in management of the trauma patients. This review also assesses the still ongoing, controversial debate of the best fit treatment options. This research is clarifying trauma system requirements for new blood products and blood-product usage patterns, but the inability to obtain informed consent from severely injured patients remains an obstacle to further research.
Methods: We considered systematic reviews identified through searches of Cochrane databases from inception to April 2015 and PubMed up to April 2015.
Results and Conclusions: Polytrauma patients with severe shock from haemorrhage and massive tissue injury present major challenges for management and resuscitation. Many of the current recommendations for damage control resuscitation remain controversial. A lack of large, randomized, control trials leaves most recommendations at the level of consensus and expert opinion. Ongoing trials and improvements in monitoring and resuscitation technologies will further influence how we manage these complex and challenging patients.
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| Keywords |
| Massive hemorrhage, Post injury coagulopathy, Thromboelastography, Damage control resuscitation, Transfusion protocols, Trauma center. |
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