Transfusion érythrocytaire en urgence

Abstract

Indication of blood transfusion is frequent in only some of the clinical situations encountered in emergency departments: severe trauma, gastrointestinal bleeding, and peripartum hemorrhage. In most situations, the usual recommendations concerning blood transfusion must be applied. In the emergency setting, some modifications are thought to be required but they are usually not evidence-based. The clinical conditions in which the transfusion triggers might be increased are those with a high rate of hemorrhage requiring anticipated blood transfusion, those where hematocrit can play a key role in hemostasis (severe head trauma, retroperitoneal hematoma), and those where cerebral circulation is crucial (severe head trauma with uncontrolled intracranial hypertension). Many recommendations (choice of donor’s blood group, distant blood storage) come from regulatory agencies. Lastly, to prevent blood transfusion has become an important objective even in emergency conditions (limitation of hemodilution, treatment of hypotensive factors non-related to hypovolemia, early embolization, damage control surgery), and autotransfusion is the only alternative therapy yet available.