title: Problems with 20 or more blood transfusions in 24 hours.
abstract: The case records of 128 patients receiving 129 transfusions of 20 or more units of blood within a 24-hour period at Detroit Receiving Hospital, between August 1980 and August 1985, were reviewed. In patients receiving 20 to 49 units of blood, without pre-existing disease or prolonged shock, the mortality rate was 36 per cent (15/42). In similar patients who had prolonged shock, the mortality rate was 61 per cent (27/44). If the patient had pre-existing disease and prolonged shock, the mortality rate with 20 to 49 units of blood was 92 per cent (12/13). All 13 patients receiving 50 or more units of blood died. Platelet counts were less than 50,000/microL in 50 per cent (51/102). The prothrombin time (PT) was prolonged by 5 or more seconds in 54 per cent (51/92). The partial thromboplastin time (PTT) was prolonged to more than 60 seconds in 45 per cent (42/94). There was no correlation between the PT, PTT, and amount of fresh frozen plasma (FFP) given. A coagulopathy was diagnosed clinically in 43 patients, but this did not correlate well with laboratory coagulation studies. The average core temperature of the patients was 32.9 +/- 1.7 C. Severe hypocalcemia with total calcium levels less than 6.0 mg/dL was found in 53 per cent (33/62). Ionized calcium levels Ca++ were less than 0.70 mmol/L in 56 per cent (24/43). Of the 82 deaths, 32 (38%) occurred in the operating room and 31 (38%) occurred within 48 hours from continued bleeding and/or shock. Twelve deaths (15%), from severe infections, occurred after 30 days.(ABSTRACT TRUNCATED AT 250 WORDS)
mesh_terms: D000138:Acidosis / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000209:etiology; D001778:Blood Coagulation Disorders / Q000097:blood / Q000209:etiology; D001803:Blood Transfusion / Q000401:mortality; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology; D007035:Hypothermia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D011517:Prothrombin Time; D012774:Shock, Traumatic / Q000628:therapy; D013997:Time Factors; D065227:Transfusion Reaction; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality