THE COMPLICATIONS OF MASSIVE BLOOD TRANSFUSION

Abstract

Patients receiving anticoagulants or thrombolytics are at increased risk of bleeding. Large amounts of blood may be lost before the reversal of drug-induced coagulopathy can occur. Replacement of extensive blood loss or massive blood transfusion is defined as the administration of more than one blood volume over 24 hours. For perspective, the red cell mass of a 70-kg male is approximately equivalent to that of 12 units of packed red cells. The management of massive blood transfusion presents the clinician with challenges not frequently encountered during the routine administration of blood products. Discussed in this article are the significant complications of massive blood transfusion. Specifically omitted are the complications of volume overload and iron overload, the former because the management of fluid resuscitation is a topic well appreciated by most anesthesiologists, and the latter because it represents an issue more for caregivers of chronically ill patients with hemoglobinopathies. Similarly, this article does not discuss the immunologic or infectious complications of blood transfusion, as these are not specifically unique to massive blood transfusion. The complications of massive blood transfusion that are discussed in this article are either rate related, occurring in the setting of a rapid rate of administration of blood, or are volume related, occurring after the