Assessing response to changing plasma/red cell ratios in a bleeding trauma patient.
Recent military experience suggests that transfusing fresh frozen plasma and packed red cells in a 1:1 ratio may improve survival in exsanguinating trauma patients. We report the case of a single patient who required massive transfusion after suffering a single gunshot wound. Initially, the patient received FFP:PRBC in 1:2 ratio, but this did not correct laboratory parameters except for INR and clotting factor VII level, which were likely normalized by treatment with recombinant activated factor VII. After receiving FFP:PRBC in a 4:5 ratio, he continued to bleed and his coagulation profile showed no appreciable improvement. In the final phase, he received FFP:PRBC in a 7:5 ratio and his laboratory parameters of coagulopathy normalized, except for factor V level which was improved. He also clinically stopped bleeding.
Tien
Homer C
HC
Canadian Forces Health Services, Tory Regional Trauma Centre and the Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5. homer.tien@sunnybrook.ca
Scarpellini
Sandro
S
Callum
Jeannie
J
Tremblay
Lorraine
L
Rizoli
Sandro
S
D001778:Blood Coagulation Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001780:Blood Coagulation Tests; D016913:Blood Component Transfusion / Q000379:methods*; D017707:Erythrocyte Transfusion; D017809:Fatal Outcome; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D010388:Pelvis; D010949:Plasma; D014948:Wounds, Gunshot / Q000150:complications* / Q000628:therapy