Ferrara et al identified risk factors for clinical coagulopathy and death in trauma patients receiving massive blood transfusion. The authors are from Yale University, Bridgeport Hospital and the New Haven VA Medical Center.


Patient selection:

(1) age range 15 to 65 years

(2) severe Injury Severity Score (mean 54)

(3) massive transfusion (> 12 packed red blood cell units in first 12 hours; average total transfusion was 23 units)

(4) excluded if head injury or if significant comorbid medical condition were present


Risk factors for coagulopathy:

(1) hypothermia < 34°C

(2) acidosis (pH < 7.15)


The coagulopathy that developed in the setting of severe hypothermia and/or acidosis occurred despite adequate plasma and platelet replacement. It was characterized by:

(1) continued blood oozing despite attempts to control

(2) recurrence after initial hemostasis

(3) oozing from needle puncture sites

(4) mucosal bleeding


Risk factors for death:

(1) penetrating trauma

(2) more transfusions of packed red blood cells (>= 20 units)

(3) severe acidosis

(4) severe hypothermia

(5) coagulopathy not associated with inadequate plasma and FFP replacement for the massive transfusion


NOTE: I did not see a discussion on DIC, lactic acidosis, cryoprecipitate or use of blood warmers in the patients.


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