Transfusion in Trauma

Merve HAVANa , Tanıl KENDİRLİa

aAnkara University Faculty of Medicine, Department of Pediatric Intensive Care, Ankara, Türkiye

ABSTRACT
Hemorrhagic shock is the leading cause of mortality in traumatized pediatric patients, and rapid intervention is required. In pediatric patients, hypotension occurs when 30-45% of the blood volume is lost and is, therefore, a late finding. Hemorrhagic shock must be ruled out if tachycardia is present. Children have physiologic differences from adults. While early plasma therapy is recommended in prehospital care for adults, the clinician’s decision is important in children. The use of tranexamic acid is recommended for hemorrhagic trauma. After vascular access is established, treatment with intravenous crystalloid agents can be initiated until blood products are available. However, it should be noted that crystalloid agents are associated with trauma-related coagulopathy. Whole blood is the first choice for transfusion; if it is not available, other blood products are administered. It is recommended that an erythrocyte suspension/plasma/platelet suspension be administered in a 1/1/1 ratio for massive transfusions. In emergencies, blood group O Rh- is the universal donor. In the presence of hypofibrinogenemia, fibrinogen supplementation should be given. Although there is no firm data on thromboelastography, its use in the management of bleeding is recommended because it provides rapid results. Clinical trials are currently underway on the use of new hemostatic agents derived from blood and plasma derivatives (dried plasma, cold-stored platelets).
Keywords: Trauma; hemorrhage; shock; transfusion; child; intensive care units, pediatric

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