Massive Haemorrhage With Massive Transfusion of Blood
Definition Diagnostic Criteria Medicine Treatment Referral DEFINITION Massive blood loss in children is recognised when a child requires a blood transfusion to replace 50% of total blood volume in 3–4 hours (40 mL/kg) or > 100% of total blood volume in 24 hours or receives replacement of 10% of total blood volume/minute. The rapid recognition is important to maintain tissue oxygenation by rest
DEFINITION
Massive blood loss in children is recognised when a child requires a blood transfusion to replace 50% of total blood volume in 3–4 hours (40 mL/kg) or > 100% of total blood volume in 24 hours or receives replacement of 10% of total blood volume/minute. The rapid recognition is important to maintain tissue oxygenation by restoration of blood volume and haemoglobin.
Common causes:
- Trauma (especially blunt injuries).
- Ruptured aortic aneurysm.
- Liver surgery.
- Gastrointestinal bleeding.
- Invasive tumour.
Presentation: Hypotension, prolonged capillary fill time, tachycardia, urinary output decreases, oxygen saturation reduced, hypothermia.
DIAGNOSTIC CRITERIA
Investigations
- ABG, Thromboelastogam (TEG), haemoglobin, PT/PTT, platelets, INR, clotting factors, DIC screening.
- Haemoglobin must be done initially and repeated every 60 minutes.
MEDICINE TREATMENT
Massive transfusion protocol (MTP) activation must be prompt as every minute from activation to product arrival increases odds of mortality by 5%.
Facilities without access to a blood bank:
- Lyophilised plasma, IV.
- 1 unit for each unit of emergency blood transfused.
Arrange urgent transfer to a centre with blood bank and specialist services.
Facilities with access to a blood bank:
- Ensure that the blood bank receives an appropriate specimen as soon as the possible need for transfusion is identified.
- Notify the blood bank as soon as possible of the need for a massive transfusion and request a massive transfusion pack.
A massive transfusion pack will typically consist of:
- Red blood cells (RBCs).
AND
- Lyophilised plasma, IV.
- 1 unit for each unit of emergency blood transfused.
OR
- FFP – thawed when requested.
AND
- Platelets
- Aim to transfuse the above products in a 1:1:1 ratio, or as guided by laboratory parameters.
- Send specimens for FBC and INR and continue to monitor.
Watch for complications:
- Electrolyte abnormalities:
- Hyperkalaemia
- Hypocalcaemia
- Transfusion:
- Induced coagulopathy.
- Immunologic reactions:
- ABO incompatibility.
- Transfusion-related acute lung injury.
- Transfusion-associated circulatory overload.
- Alloimmunization
REFERRAL
- All
- MTP deactivation must be stopped timeously to decrease wastage and adverse effects.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 1: Emergencies and Trauma, 1.1 Paediatric Emergencies,
1.1.9
Massive Haemorrhage With Massive Transfusion
of Blood