Transfusion therapy in emergency medicine

Margot S. Kruskall, Paul D. Mintz, James J. Bergin, Marilyn FM Johnston, Harvey G. Klein, Jacqueline D. Miller, Roanne Rutman, Leslie Silberstein

Research output: Contribution to journalArticlepeer-review

Abstract

Volume replacement is critical to the resuscitation of the hemorrhaging patient, but this usually can be accomplished quickly and safely with crystalloid and/or colloid solutions. Red cells should be used in addition to asanguinous fluids in the treatment of tissue hypoxia due to anemia. The need for whole blood as opposed to packed red blood cells is controversial. However, plasma should not be used as a volume expander, and its use to supplement coagulation factors during the massive transfusion of red cells should be guided by laboratory tests that document a coagulopathy. Similarly, platelet transfusions are indicated to correct documented thrombocytopenia or platelet dysfunction, and routine prophylaxis after fixed volumes of red cells results is unwarranted. Many anticipated complications of massive transfusions, including hemostatic abnormalities, acid-base imbalances, hyperkalemia, and hypocalcemia, are uncommon or of limited clinical significance. The risks of immune hemolysis and transfusion-transmitted diseases, on the other hand, are significant, and argue for judicious use of blood components. In emergencies in which blood is required immediately before compatibility testing can be completed, O-negative uncrossmatched blood can be requested. Careful blood specimen collection and patient identification prior to transfusion are critical. Practices that emphasize blood conservation, including the use of autologous salvaged blood, are always to the patient's advantage.

Original languageEnglish (US)
Pages (from-to)327-335
Number of pages9
JournalAnnals of Emergency Medicine
Volume17
Issue number4
DOIs
StatePublished - 1988
Externally publishedYes

Keywords

  • emergency
  • medicine
  • tranfusion
  • use

ASJC Scopus subject areas

  • Emergency Medicine

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