Hemostatic Abnormalities in Massive Transfusion

Description 

Clinically significant haemostatic abnormalities complicating massive transfusion can occur due to dilution and depletion of coagulation proteins and platelets.

Decreased platelet counts may complicate massive transfusion of components which do not contain platelets. Thrombocytopenia is usually not as severe as predicted by simple hemodilution. With red blood cell replacement for loss of up to one blood volume, clotting factor levels may be reduced to 25% of normal and PT INR measurements may be slightly prolonged without clinical coagulopathy.

50% of massively transfused patients develop an INR >2.0 and about 33% have thrombocytopenia with a platelet count <50 x 109/L. Disseminated intravascular coagulation (DIC) occurs in 5-30% of massively transfused trauma patients.

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