Transfusion in trauma: why and how should we change our current practice?
OBJECTIVE
Major trauma is often associated with hemorrhage and transfusion of blood and blood products, which are all associated with adverse clinical outcome. The aim of this review is to emphasize why bleeding and coagulation has to be monitored closely in trauma patients and to discuss the rationale behind modern and future transfusion strategies.


RESULTS
Hemorrhage is a major cause of early death after trauma. Apart from the initial injuries, hemorrhage is significantly promoted by coagulopathy. Early identification of the underlying cause of hemorrhage with coagulation tests (routine and bedside) in conjunction with blood gas analysis allow early goal-directed treatment of coagulation disorders and anemia, thereby stopping bleeding and reducing transfusion requirements. These treatment options have to be adapted to the civilian and noncivilian sector. Transfusion of blood and its components is critical in the management of trauma hemorrhage, but is per se associated with adverse outcome. Decisions must weigh the potential benefits and harms.


CONCLUSIONS
Future transfusion strategies are based on early and continuous assessment of the bleeding and coagulation status of trauma patients. This allows specific and goal-directed treatment, thereby optimizing the patient's coagulation status early, minimizing the patient's exposure to blood products, reducing costs and improving the patient's outcome.
Theusinger
Oliver M
OM
Institute of Anesthesiology, University Hospital and University of Zurich, Zurich, Switzerland. oliver.theusinger@usz.ch
Spahn
Donat R
DR
Ganter
Michael T
MT
D000465:Algorithms; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D001803:Blood Transfusion / Q000379:methods* / Q000592:standards; D015942:Factor VIIa / Q000627:therapeutic use; D005176:Factor XIII / Q000627:therapeutic use; D005340:Fibrinogen / Q000627:therapeutic use; D006470:Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D011994:Recombinant Proteins / Q000627:therapeutic use; D065227:Transfusion Reaction; D014947:Wounds and Injuries / Q000150:complications* / Q000628:therapy
D001779:Blood Coagulation Factors; D011994:Recombinant Proteins; C025667:prothrombin complex concentrates; D005340:Fibrinogen; D005176:Factor XIII; C103587:recombinant FVIIa; D015942:Factor VIIa