A patient presented with blunt abdominal injury underwent complete repair of liver; and was given transfusion of 12 units of whole blood. Thereafter, it is found that wound is bleeding. It is treated by
(D) Platelets rich plasma > Massive Transfusion is usually defined as the need to transfuse from one to two times the patient's normal blood volume. In a "normal" adult, this is the equivalent of 10-20 units. Potential complications from this include coagulopathy, citrate toxicity, hypothermia, acid-base disturbances and changes in serum potassium concentration. Coagulopathy is common with massive transfusion. The most common cause of bleeding following a large volume transfusion is dilutional thrombocytopenia. This should be suspected and treated first before moving on to factor deficiencies as the cause of coagulopathy. Patients who may require multiple transfusions are best second by receiving SPAP and leucocyte reduced components to lower the risk of autoimmunization. Citrate toxicity results when the citrate in the transfused blood begins to bind calcium in the patient's body. Clinically significant hypocalcemia does not usually occur unless the rate of transfusion exceeds one unit every five minutes or so. Citrate metabolism is primarily hepatic - so hepatic disease or dysfunction can cause this effect to be more pronounced. Treatment is with intravenous calcium administration - but identification of the problem requires a high index of suspicion. Hypothermia should not occur on a regular basis. Massive transfusion is an absolute indication for the warming of all blood and fluid to body temperature as it is being given.Acid-Base balance can be seen after massive transfusion. The most common abnormality is a metabolic alkalosis. Patients may initially be acidotic because the blood load itself is acidic and there may be a prevailing lactic acidosis from hypoperfusion. However, once normal perfusion is restored, any metabolic acidosis resolves and the citrate and lactate are then converted to bicarbonate in the liver. Serum potassium can rise as blood is given. The potassium concentration in stored blood increases steadily with time. The amount of potassium is typically less than 4 milliequivalents per unit - so you can see that large amounts of blood at a high rate of delivery is required to raise serum levels of potassium.
Calcium gluconate/calcium chloride
Fresh Frozen Plasma
Vitamin-K
Platelets rich plasma
Miscellaneous