A reply

Abstract

Thank you for showing me the letter by Crera-Gilbert and Raveendran. They have rightly corrected my statement about platelet function and haematocrit which should have read that bleeding time is inversely related to haematocrit. Another correction is that approximately 30% of donor units (not 12%) have platelets removed from them in the buffy cell layer. I agree that bleeding time is an impractical as well as imprecise test in the massive transfusion setting and thromboelastography combined with the platelet count is more appropriate. A maximum amplitude of less than 40 mm is an indication for 2–3 ATDs of platelet concentrates. I hope others correctly inferred that craniofacial injuries unaccompanied by neurological signs should be an indication to suspect intracranial bleeding and to act accordingly. I plead not guilty to attempting a comprehensive review of the literature or to quoting multiple contradictory opinions. The only example of this was to point out that Harke and Rahman's [1] main theme based on a small and inadequately described series was not supported by Mannuchi et al. [2] in their much larger series. My view is that platelets and other blood products should be available to anaesthetists more readily than they have been and the constraints imposed by Mollison's textbook [3] (repeated in the 10th edition since the editorial was written) should be reconsidered by those who use blood as well as those whose task it is to see that it is not abused.