title: Logistics of transfusion support for patients with massive hemorrhage.
abstract: OBJECTIVE
  Traditionally, trauma resuscitation protocols have advocated sequential administration of therapeutic components, beginning with crystalloid solutions infused to replace lost intravascular volume. However, rapid restoration of the components of blood is essential for ensuring adequate tissue perfusion and for preventing acidosis, coagulopathy, and hypothermia, referred to as the 'lethal triad' in trauma settings. The review summarizes practical approaches for transfusion support of patients with massive hemorrhage.
  
  
  RESULTS
  Massive transfusion protocols for blood transfusion support are reviewed, including practical considerations from our own. We maintain an inventory of thawed, previously frozen plasma (four units each of blood group O and A), which can be issued immediately for patients in whom the blood type is known. As frozen plasma requires 45 min to thaw, liquid AB plasma (26 day outdate) functions as an excellent alternative, particularly for patients with unknown or blood group B or AB types.
  
  
  CONCLUSIONS
  Close monitoring of bleeding and coagulation in trauma patients allows goal-directed transfusions to optimize patients' coagulation, reduce exposure to blood products, and to improve patient outcomes. Future studies are needed to understand and demonstrate improved patient outcomes.
authors: Department of Pathology, Stanford University, Stanford, California, USA. ltgoodno@stanford.edu
authors: Lawrence T
authors: LT
authors: Goodnough
authors: David A
authors: DA
authors: Spain
authors: Paul
authors: P
authors: Maggio
mesh_terms: D001778:Blood Coagulation Disorders / Q000628:therapy; D001803:Blood Transfusion; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D019095:Point-of-Care Systems; D013916:Thrombelastography