Risks and complications of massive blood transfusion

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Blood transfusion is an effective and frequently prescribed treatment for anemia patients in all medical departments, especially patients with acute blood loss. In some cases, such as obstetric complications or surgical surgery, a large blood transfusion is necessary but also brings certain risks and complications of blood transfusion.

1. What is Mass Blood Transfusion?

Mass transfusion is the infusion of large volumes of blood over a short period of time in patients with severe or uncontrolled bleeding. For adults, a bulk transfusion is when an amount equal to the patient's blood volume is transfused in 24 hours or more than or from 10 units of red blood cells in 24 hours. There are also definitions such as infusion of 4 units of RBC in 1 hour and predicting need for continued transfusion or replacement transfusion of more than 50% of the patient's total blood volume in 3 hours

2. Complications of massive blood transfusion

Although large volume blood transfusion can help patients get out of the critical stage, there are still many potential risks and dangerous blood transfusion complications that need to be handled promptly.
Bleeding Complications The most common cause of bleeding after massive transfusion is a decrease in platelet volume and coagulation factors due to blood dilution. However, thrombocytopenia does not always occur after a complete blood volume replacement, but usually occurs only after 1.5-2 times the blood volume is replaced. Bleeding usually occurs due to thrombocytopenia associated with platelet dysfunction due to liver disease or disseminated intravascular coagulation and coagulation factor deficiency. Coagulation factor deficiency after massive blood transfusion is due to low blood storage of clotting factors. The disorder is aggravated in the presence of hypothermia, acidosis or shock, infection
Management: Transfusion of platelets and plasma fresh, fresh frozen plasma
Complications of citrate toxicity and hypocalcaemia Citrate is an important part of blood preservation solutions, therefore, large blood transfusions can cause complications of citrate toxicity but not citrate ion. but because citrate is attached to calcium
Calcium when attached to citrate significantly reduces the amount of calcium ions in the blood, so the manifestations of citrate toxicity are actually symptoms of hypocalcemia causing hypotension, weak pulse, pressure ventricular end-diastolic force and central venous pressure increase
Management: Intravenous infusion of calcium chloride solution or calcium gluconate (more commonly used calcium chloride because calcium gluconate will cause the liver to metabolize water gluconate
Complications lower A body temperature of C can occur when large volumes of blood are transfused stored at 4 ± 2 °C or c when the body temperature falls below 30 °C can cause ventricular fibrillation and cardiac arrest, when the body temperature falls below 35 °C can increase the risk of coagulopathy.
To prevent this possible complication by warming the blood up to body temperature before infusing the patient, blood and fluid warming devices should be used in conjunction with patient warming devices
Complications acid-base balance disorder Caused by the pH of most of the environment, the blood reserve is very complete, so when putting this solution into 1 unit of freshly drawn blood, it can cause the blood pH to drop to 7-7. ,first. The accumulation of lactic acid and pyruvic acid by erythrocyte metabolism and glucose hydrolysis causes the blood pH to continue to fall to about 6.9 after 21 days of storage
Mass transfusion can cause early metabolic acidosis as soon as it is started. First
Management: Treatment of hemorrhagic shock with hypertension and tissue perfusion can correct the acidosis
Complications of hyperkalemia Due to blood preservation from day 15 onwards may appear erythrocyte rupture causes potassium release, so large volume transfusions have a risk of hyperkalemia for patients
Complications of circulatory overload Mass blood transfusions can cause circulatory overload, the most dangerous is edema Pulmonary edema , so fluids should be administered based on monitoring of urine flow and central venous pressure.

3. Principles when selecting blood and blood products for mass transfusion:

To avoid complications of massive blood transfusion, it is very important to choose the right blood and blood products, and the following principles should be adhered to:
Ensure optimal ABO and Rh blood group matching between Donor and recipient and perform the appropriate test on each unit of blood Type O blood with low antibody titres can be used as an alternative in the absence of allogeneic blood In the case of using whole blood from different groups In order to transfuse a patient and do not have group O red blood cells, one must find every way to ensure that blood group during the emergency period for the patient. Transfusion blood needs to be maintained at 37 degrees Celsius by means of blood warming. used for bulk infusion should preferably be stored for 72 hours or no longer than 5 days. If it is longer, it is necessary to combine the use of fresh frozen plasma or a combination of red blood cells and frozen plasma. Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in medical examination and treatment, patients can rest assured to visit. and hospital treatment.
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