Complications and management of massive transfusion in a table format

Complication	Mechanisms	Management
Coagulopathy	Dilution Depletion Disseminated Intravascular Coagulation (DIC)	Monitor patient coagulation parameters If INR/aPTT is ≥ 1.5-2.0 consider transfusing FFP If fibrinogen is < 1.0 g/L consider transfusing cryoprecipitate
Thrombocytopenia	Dilution Depletion Disseminated Intravascular Coagulation (DIC)	Monitor patient platelet counts If platelet count falls below 50 X 10/L consider transfusing platelets
Hypothermia	Infusion of cold IV fluids and blood products	Monitor patient temperature Consider warming the patient and/or blood components
Hypocalcemia	Calcium chelation by citrate	Monitor the patient for arrhythmias and calcium levels Initiate intravenous calcium therapy if indicated
Hyperkalemia	Rapid transfusion of older cells (potassium concentration increases in RBC units with storage time and after irradiation; neonates may be more susceptible)	Monitor patient electrolytes and ECG; consider treatment to lower serum potassium
Metabolic Acidosis	Shock Acid pH of blood components	Monitor patient pH, and correct imbalance if indicated

Adapted with permission from the Transfusion Manual for Nursing Units from St. Michaels Hospital, Toronto Ontario. Canada.

Vein to Vein

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