Coagulation disorders after massive transfusion

Massive transfusion is most commonly defined as the replacement of the pati ent's total blood volume by stored homologous whole blood or red cell conce ntrates within 24 hours. In approximately 20-30% of patients, usually after transfusion of 20 units, a complex bleeding disorder can be observed. The clinical characteristics of microvascular bleeding (MVB) are (a) bleeding f rom mucous membranes, (b) bleeding from catheter or venepuncture sites, (c) oozing from raw surfaces, (d) generalised petechiae and (e) increasing siz e of ecchymoses. The best predictive value for the development of MVB have a platelet count of less than 50,000/ mu L, fibrinogen levels less than 50 mg/dl, or coagulation factors less than 20 - 30% of normal. Elevated prothr ombin times (PT) or partial thromboplastin times (PTT), greater 1.5 times n ormal, are also predictive for bleeding. Platelet concentrates and fresh frozen plasma are the treatment of first ch oice, when clotting factor concentrates have to be administered, antithromb in levels should be normalized.