Massive Blood

Transfusion
Massive transfusion, defined as the
replacement by transfusion of more than
50 percent of a patient's blood volume in
12 to 24 hour,
may be associated with a number of
hemostatic and metabolic complications
1

Bleeding due to Dilution of clotting

factors
Patients receiving large volumes of blood
can develop a bleeding disorder due to
dilution of coagulation factors & platelets
Stored blood has low levels of the:
clotting factors VIII and V
Does not contain functional platelets

Significant depletion occur when patients

blood is replaced more than twice within
24 hrs
2

 The administration of:

platelet concentrates
cryoprecipitate
and fresh frozen plasma

can prevent this complication to patients

receiving massive transfusions

Citrate Toxicity & Hypocalcemia

Large amounts of citrate are given with massive
blood transfusion
Since blood is anticoagulated with sodium
citrate.
A decline in the plasma free calcium
concentration is the potential complication of
citrate infusion and accumulation.
Calcium supplements should be given if patient
has evidence of hypocalcemia
This rarely occur unless one unit is given every 5
minutes or a patient has impaired liver function
4

Hypothermia
Rapid transfusion of multiple units of
chilled blood may reduce the core
temperature abruptly
This can lead to cardiac
arrhythmias.
This also increases the affinity of Hb
to O2 resulting in poor O2 delivery to
tissues
Thus, during massive transfusion, a
commercial blood warmer should be
used to warm blood toward body
temperature during infusion.
5

2,3 DPG Deficiency

During storage erythrocytes concentration of
2,3-DPG falls
This increases affinity of Hb to O2 less
efficient in delivery of O2
Rapid infusion of 2,3-DPG depleted cells could
contribute to tissue hypoxia
Transfused blood regenerates 2,3-DPG within
hours of infusion
Also, the use of CPD-A avoid this problem as
rate of depletion decreases gradually
6

Hyperkalemia
Plasma potassium levels in stored blood increase
due to passive leakage of potassium out of red cells
By 3 weeks the level is approx. 30 mEq/l
This excess potassium does not usually lead to a
significant rise in the plasma potassium
concentration due to movement into the cells,
urinary excretion, and dilution.
However, infants and patients with renal impairment
may develop hyperkalemia.

Microemboli
During storage, white cell & platelet
fragments aggregate to form microscopic
debris or microemboli
These can pass through standard blood
bank filters
They can embolize to the lungs, but have
not been reported to cause morbidity