title: Recommendations for the management of trauma or surgery-related massive blood loss.
abstract: Exsanguination is an underestimated cause of treatment failures in patients with severe trauma or undergoing surgery. In some patients the primary dysfunction of blood clot formation is a direct cause of a massive blood loss. Patients without previous coagulation disorders are at risk of coagulopathy following intraoperative or post-traumatic bleeding, where the local haemostasis does not warrant bleeding cessation.
  
  
  OBJECTIVE
  was to assess the therapeutic value of various components of a complex interdisciplinary approach, based on the opinion of the experts treating patients with massive bleeding.
  
  
  METHODS
  The study was conducted by anonymous questionnaire, using the analogue representation of the argument strength. The results were analyzed based on the techniques of descriptive statistics. The argument was considered a key parameter, when the median value of strength was located in the highest quartile.
  
  
  RESULTS
  It was found that the arguments of the highest strength for the risk of developing the posthaemorrhagic coagulation disorders are: loss of more than one third of blood volume, fluid therapy in an amount greater than 35 ml/kg, administration of more than 5 units of packed red blood cells, insufficient supply of fresh frozen plasma and platelets in proportion to packed red blood cells, severe acidosis and hypothermia. The most important tests for post-haemorrhage coagulopathy are: anatomically non-localized bleed, abnormal values of the standard coagulation parameters and fibrinogen level below 1 g/L. In the treatment of post-haemorrhagic coagulopathy the team of experts pointed out the benefits of antifibrinolytic drugs, concentrates of prothrombin complex and recombinant activated coagulation factor VII.
  
  
  CONCLUSIONS
  Multidisciplinary therapeutic management of bleeding patients is associated with employment of appropriate treatment methods to achieve the best possible outcome. Factors influencing the development of coagulopathy, the methods of diagnosis and proposed techniques of treatment may facilitate therapeutic decisions in bleeding patients requiring massive transfusion of blood components.
authors.affiliation: Association for Severe Bleeding Care Department of Gastrointestinal Surgery, St. John from Dukla Lublin Regional Cancer Centre.
authors.forename: Piotr
authors.initials: P
authors.lastname: Paluszkiewicz
authors.forename: Ewa
authors.initials: E
authors.lastname: Mayzner-Zawadzka
authors.forename: Włodzimierz
authors.initials: W
authors.lastname: Baranowski
authors.forename: Grzegorz H
authors.initials: GH
authors.lastname: Bręborowicz
authors.forename: Maciej
authors.initials: M
authors.lastname: Brzeziński
authors.forename: Grażyna
authors.initials: G
authors.lastname: Durek
authors.forename: Adam
authors.initials: A
authors.lastname: Dziki
authors.forename: Maria M
authors.initials: MM
authors.lastname: Czupryńska
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Lipińska-Gediga
authors.forename: Magdalena
authors.initials: M
authors.lastname: Lętowska
authors.forename: Andrzej
authors.initials: A
authors.lastname: Mital
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Nowacka
authors.forename: Magdalena
authors.initials: M
authors.lastname: Pychyńska-Pokorska
authors.forename: Jerzy
authors.initials: J
authors.lastname: Ratajczak
authors.forename: Jan
authors.initials: J
authors.lastname: Rogowski
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Rybicki
authors.forename: Sławomir
authors.initials: S
authors.lastname: Sobieszczyk
authors.forename: Radzisław
authors.initials: R
authors.lastname: Trzciński
authors.forename: Marta
authors.initials: M
authors.lastname: Wawrzynowicz-Syczewska
authors.forename: Jerzy
authors.initials: J
authors.lastname: Windyga
authors.forename: Maria
authors.initials: M
authors.lastname: Wujtewicz
mesh_terms: D001778:Blood Coagulation Disorders / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D001803:Blood Transfusion / Q000592:standards; D005440:Fluid Therapy / Q000592:standards; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D010348:Patient Care Team; D017713:Platelet Transfusion / Q000706:statistics & numerical data; D011159:Population Surveillance; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000628:therapy; D011994:Recombinant Proteins; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000150:complications* / Q000601:surgery
chemical_list: D001779:Blood Coagulation Factors; D011994:Recombinant Proteins