Transfusion in trauma

  • Víctor Hugo González Cárdenas a. Clinical Epidemiologist La Samaritana University Hospital, "Mandragora". b. Anesthesia Research Group, Anesthesiologist, San José Children's Hospital. c. Head of Anesthesia Research Deorum Opus-FUCS. d. Intensivist, University Clinic Colombia-Sanitas Internacional. e. Instructor of Anesesiology - FUCS, Clnical. f. Professor, Universidad de la Sabana, Graduate Program in Anesthesiology, Bogotá, Colombia
Keywords: Hemorrhage, Blood transfusion, Trauma, Recombinant FVIIa, Tranexamic acid, Coagulopathies


Massive transfusion is considered a key component in the acute management of massive hemorrhage. While the existing protocols do not standardize its use, they do recommend its timely administration and a dose adjusted to the type of blood product, a proportionate ratio between hemocomponents and appropriate adjuvant drug support, in addition to techniques that promote bleeding control and prevent syndromes that could trigger a fatal outcome. This non-systematic review is intended to summarize the current concepts on the acute management of massive bleeding in trauma, from a non-surgical perspective.

The search was limited to the articles of the last 10 years and included primary and secondary data basis, leading to a snowball technique.


1. Kauvar D, Wade C. The epidemiology and modern management of traumatic hemorrhage: US and international perspectives. Crit Care. 2005;9 Suppl. 5:S1-9.

2. Schulman C, Cohn S. Transfusion in surgery and trauma. Crit Care Clin. 2004;20:281-97.

3. Charles A, Shaikh A, Walters M, Huehl S, Pomerantz R. Blood transfusion is an independent predictor of mortality after blunt trauma. Am Surg. 2007;73:1-5.

4. Grottke O, Henzler D, Rossaint R. Use of blood and blood products in trauma. Best Pract Res Clin Anaesthesiol. 2007;21:257-70.

5. Tien H, Nascimento Jr B, Callum J, Rizoli S. An approach to transfusion and hemorrhage in trauma: current perspectives on restrictive transfusion strategies. Can J Surg. 2007;50:202-9.

6. Mock C, Joshipura M, Quansah R, Arreola-Risa C. Advancing injury prevention and trauma care in North America and globally. Surg Clin North Am. 2007;87:1-19.

7. Hoyt DB, Coimbra R. Trauma systems. Surg Clin North Am. 2007;87:21-35.

8. Holcomb JB, Jenkins D, Rhee P, Johannigman J, Mahoney P, Mehta S, et al. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma. 2007;62:307-10.

9. National Blood Data Resources Center (NBDRC). Comprehensive report on blood collection and transfusion in the United States in 2001. Bethesda: NBDRC; 2002.

10. Fraga G, Bansal V, Coimbra R. Transfusion of blood products in trauma: an update. J Emerg Med. 2010;39:253-60.

11. Bickell WH, Wall Jr MJ, Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994;331:1105-9.

12. Tieu B, Holcomb J, Schreiber M. Coagulopathy: its pathophysiology and treatment in the injured patient. World J Surg. 2007;31:1055-64.

13. González E, Moore F, Holcomb J, Miller C, Kozar R, Todd S, et al. Fresh frozen plasma should be given earlier to patients requiring massive transfusion. J Trauma. 2007;62:112-9.

14. Boffard KD, Riou B, Warren B, Choong PI, Rizoli S, Rossaint R, et al. Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized placebo-controlled double-blind clinical trials. J Trauma. 2005;59:8-18.

15. Jiménez J, de la Pena J, Teherán R, Orozco A. Coagulopatía temprana en trauma ¿Llegan los pacientes coagulopáticos a la sala de cirugía? Rev Colomb Anestesiol. 2011;38:510-25.

16. Bruns B, Lindsey M, Rowe K, Brown S, Minei JP, Gentilello LM, et al. Hemoglobin drops within minutes of injuries and predicts need for an intervention to stop hemorrhage. J Trauma. 2007;63:312-5.

17. Reiner T, Ho A, Yeung J, Cheung N, Wong R, Tang N, et al. Early risk stratification of patients with major trauma requiring massive blood transfusion. Resuscitation. 2011;82:724-9.

18. Repine T, Perkins J, Kauvar D, Blackborne L. The use of fresh whole blood in massive transfusion. J Trauma. 2006;60 Suppl.6:S59-69.

19. Geeraedts Jr L, Demiral H, Schaap N, Kamphuisen P, Pompe J, Frolke J. Blind transfusion of blood products in exsanguinating trauma patients. Resuscitation. 2007;73:382-8.

20. Klein H, Spahn D, Carson J. Red blood cell transfusion in clinical practice. Lancet. 2007;370:415-26.

21. Dehmer J, Adamson W. Massive transfusion and blood product use in the pediatric trauma patients. Semin Pediatr Surg. 2010;19:286-91.

22. Scully P, Sen B, Wallis J. Major trauma and transfusion in the north east of England. Injury Extra. 2010;41:197-200.

23. Como J, Dutton R, Scalea T, Edelman B, Hess J. Blood transfusion rates in the care of acute trauma. Transfusion. 2004;44:809-13.

24. Holcomb J, Hess J. Early massive trauma transfusion: state of the art. J Trauma. 2006;60 Suppl:S1-2.

25. Rivera D, Pérez A. Técnicas de ahorro sanguíneo en cirugía. Rev Colomb Anestesiol. 2012;39:545-59.

26. Malone D, Hess J, Fingerhut A. Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol. J Trauma. 2006;60 Suppl. 6:S91-6.

27. Borgman MA, Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63:805-13.

28. Vigué B, Ract C, Tremey B, Engrand N, Leblanc PE, Decaux A, et al. Ultra-rapid management of oral anticoagulant therapy-related surgical intracranial hemorrhage. Intensive Care Med. 2007;33:721-5.

29. Holcomb J, Spinella P. Optimal use of blood in trauma patients. Biologicals. 2010;38:72-7.

30. Mabry RL, Holcomb JB, Baker AM, Cloonan CC, Uhorchak JM, Perkins DE, et al. United States Army Rangers in Somalia: an analysis of combat casualties on an urban battlefield. J Trauma. 2000;49:515-29.

31. Kauvar D, Holcomb J, Norris G, Hess J. Fresh whole blood transfusion: a controversial military practice. J Trauma. 2006;61:181-4.

32. Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, Sebesta J, et al. The risks associated with fresh whole blood and RBC transfusions in a combat support hospital. Crit Care Med. 2007;35:2576-81.

33. Spinella P, Perkins J, Grathwohl K, Beekley A, Holcomb J. Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries. J Trauma. 2009;66 Suppl. 4:S69-76.

34. Spinella P. Warm fresh whole blood transfusion for severe hemorrhage: U.S. military and potential civilian applications. Crit Care Med. 2008;36 Suppl. 7:S340-5.

35. Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, Sebesta J, et al. Fresh whole blood transfusions in coalition military, foreign national, and enemy combatant patients during Operation Iraqi Freedom at a U.S. combat support hospital. World J Surg. 2008;32:2-6.

36. Fries D, Luger T. Massive transfusion strategy or massive confusion in trauma with massive and ongoing bleeding. Resuscitation. 2011;82:1104.

37. Snyder CW, Weinberg JA, McGwin Jr G, Melton SM, George RL, Reiff DA, et al. The relationship of blood product ratio to mortality: survival benefit or survival bias? J Trauma. 2009;66:362-4.

38. McIntyre L, Hebert P. Can we safely restrict transfusion in trauma patients? Curr Opin Crit Care. 2006;12:575-83.

39. Inaba K, Lustenberger T, Rhee P, Holcomb J, Blackbourne L, Shulman I, et al. The impact of platelet transfusion in massively transfused trauma patients. J Am Coll Surg. 2010;211:573-9.

40. Sinha R, Roxby D. Change in transfusion practice in massively bleeding patients. Transfus Apher Sci. 2011;45:171-4.

41. Johansson P, Stensballe J. Effect of haemostatic control resuscitation on mortality in massively bleeding patients: a before and after study. Vox Sang. 2009;96:111-8.

42. Kashuk J, Moore E, Sawyer M, Le T, Johnson J, Biffl WL, et al. Postinjury coagulopathy management: goal directed resuscitation via POC thrombelastography. Ann Surg. 2010;251:604-14.

43. Gempeler F, Perea A, Díaz L. Tromboelastografía: evaluación global de la coagulación. Aplicaciones en el periodo perioperatorio. Rev Colomb Anestesiol. 2011;39:410-23.

44. Spahn DR, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Gordini G, et al. Management of bleeding following major trauma: a European guideline. Crit Care. 2007;11:R17.

45. Knudson MM, Cohen MJ, Reidy R, Jaeger S, Bacchetti P, Jin C, et al. Trauma, transfusions and use of recombinant factor Vila. J Am Coll Surg. 2011;212:87-95.

46. Patel M, Williams J, Bhattacharya S, Miller R, Morris J, Guillamondegui O. Cost-effectiveness of using recombinant factor Vila (rFVIIIa) in the massive transfusion protocol for severe trauma. J Am Coll Surg. 2011;10:S116.

47. Perkins J, Schreiber M, Wade C, Holcomb J. Early versus late recombinant factor Vila in combat trauma patients requiring massive transfusion. J Trauma. 2007;62:1095-101.

48. Spinella PC, Perkins JG, McLaughlin DF, Niles SE, Grathwohl KW, Beekley AC, et al. The effect of recombinant activated factor VII on mortality in combat-related casualties with severe trauma and massive transfusion. J Trauma. 2008;64:286-94.

49. Harrison TD, Laskosky J, Jazaeri O, Pasquale MD, Cipolle M. Low-dose recombinant activated factor VII results in less blood and blood product use in traumatic hemorrhage. J Trauma. 2005;59:150-4.

50. Martinowitz U, Michaelsons M. Guidelines for the use of recombinant activated factor VII in uncontrolled bleeding: a report by the Israeli multidisciplinary rFVIIa task force. J Thromb Haemost. 2005;3:1-9.

51. Vincent JL, Rossaint R, Riou B, Ozier Y, Zideman D, Spahn DR. Recommendations on the use of recombinant activated factorVII as an adjunctive treatment for massive bleeding - A European perspective. Crit Care. 2006;10:R120.

52. Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, et al., CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomized, placebo-controlled trial. Lancet. 2010;376: 23-32.

53. Curry N, Stanworth S, Hopewell S, Dorée C, Brohi K, Hyde C. Trauma-induced coagulopathy - a review of the systematic reviews: is there sufficient evidence to guide clinical transfusion practice? Transf Med Rev. 2011;25:217-31.
How to Cite
González Cárdenas VH. Transfusion in trauma. Colomb. J. Anesthesiol. [Internet]. 2012 Oct. 1 [cited 2024 Feb. 28];40(4):287–292. Available from:


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How to Cite
González Cárdenas VH. Transfusion in trauma. Colomb. J. Anesthesiol. [Internet]. 2012 Oct. 1 [cited 2024 Feb. 28];40(4):287–292. Available from:
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