Some patients get a very large number of blood products in a short period of time. While these patients are gravely ill, certain recipients have good outcomes.
Criteria for ultramassive blood transfusion:
(1) > 20 units of RBCs in first 24 hours
(1) >= 20 units of RBCs over the course of 2 consecutive calendar days
Some patients get up to 75 units of RBCs.
Clinical categories receiving ultramassive blood transfusion:
(1) solid organ transplant
(2) cardiovascular surgery
(3) general surgery
(4) trauma
(5) gastrointestinal bleeding
(6) obstetrics
Prognostic factors:
(1) total volume of blood products transfused (tends to decline with higher volumes)
(2) clinical category (above; organ transplant best; trauma worse)
(3) RBC to FFP ratio >= 1.5 or RBC to platelet ratio >= 1.5
(4) advanced age
(5) need for aortic clamping
(6) need for intraoperative inoptropes
(7) prolonged intraoperative period with systolic blood pressure less than 90 mm Hg
(8) base deficit > 12 mmol/L
