Massive transfusion can be scary, but these two discussions can help you be prepared for action!
Massive transfusion (defined variably, but most commonly as the replacement of ten or more units of RBCs in a 24 hour period of time) is an extremely challenging situation for hospital transfusion services. If the process is not well-defined in advance, confusion, chaos, and poor outcomes can result. Patients who exsanguinate and require massive transfusion support represent only 1-3% of annual emergency department admissions, but those patients can potentially use up a hospital blood bank's entire inventory very quickly.
I have two posts to share with you on massive transfusion. The first, "Five Critical Questions to Answer for All Massive Transfusions," was written by my colleague Kevin Land, MD (Senior Medical Director Field Operations at Blood Systems Inc.), and published originally on LinkedIn on June 24, 2015 (re-printed here with permission). This incredibly useful discussion gives very practical tips for managing massive transfusions. The second post is a long discussion of the philosophies behind massive transfusion and massive transfusion "protocols" written by another colleague, Tuan Le, MD (Vice President Medical Affairs, Bonfils Blood Center, Denver, CO). Dr. Le delivers a detailed discussion of the thought process behind massive transfusion management, and describes varying approaches to this potentially stressful situation.
My perspective is that the most important thing you can do is to prepare early! Don't try to have the discussion on the "appropriate" mix of products or the number of products in each "pack" in the heat of an event! Have the discussions as soon as you can, establish a protocol so that everyone knows what to do (including both the lab and the clinical team), and get the plan approved by all of the appropriate hospital committees (transfusion committee, medical executive committee, trauma committee if applicable, maternal-fetal care committee, etc.). Your preparation will make everyone's job easier, and most importantly, the patient will receive the best possible care.
I hope that you will find both posts useful.
- Five Critical Questions to Answer for All Massive Transfusions (Kevin Land, MD)
- Massive Transfusion Philosophy and Methods (Tuan Le, MD)