title: Coagulation defects associated with massive blood transfusion: A large multicenter study.
abstract: The variations in the coagulation indices of patients receiving massive blood transfusion were investigated across 20 large‑scale general hospitals in China. The data of 1,601 surgical inpatients receiving massive transfusion were retrospectively collected and the trends in the platelet counts and coagulation indices prior to and at 16 different time points during packed red blood cell (pRBC; after 2‑40 units of pRBC) transfusion were evaluated by linear regression analysis. Temporal variations in the means of prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT) and fibrinogen (FIB) concentration were also assessed and the theoretical estimates and actual measurements of the platelet count were compared. The results demonstrated that the platelet count decreased linearly with an increase in the number of pRBC units transfused (Y=150.460‑3.041X; R2 linear=0.775). Following transfusion of 18 units of pRBC (0.3 units of pRBC transfused per kilogram of body weight), the average platelet count decreased to 71x10(9)/l (<75x10(9)/l). Furthermore, variations in the means of PT, INR, APTT and FIB did not demonstrate any pronounced trends and actual platelet counts were markedly higher than the theoretical estimates. In conclusion, no variations in the means of traditional coagulation indices were identified, however, the platelet count demonstrated a significant linear decrease with an increase in the number of pRBC units transfused. Furthermore, actual platelet counts were higher than theoretical estimates, indicating the requirement for close monitoring of actual platelet counts during massive pRBC transfusion.
authors.affiliation: Department of Transfusion Medicine, The Third Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China.
authors.forename: Jiang-Cun
authors.initials: JC
authors.lastname: Yang
authors.affiliation: Department of Transfusion Medicine, The Third Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Shaanxi Provincial Center for Clinical Laboratory, The Third Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China.
authors.forename: Cui-Xiang
authors.initials: CX
authors.lastname: Xu
authors.affiliation: Department of Dermatology, The Third Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China.
authors.forename: Qian-Li
authors.initials: QL
authors.lastname: Dang
authors.affiliation: Department of Laboratory, The Third Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China.
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Urology, The Third Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China.
authors.forename: Yong-Gang
authors.initials: YG
authors.lastname: Xu
authors.affiliation: Department of Transfusion Medicine, The Third Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China.
authors.forename: Yao-Jun
authors.initials: YJ
authors.lastname: Song
authors.affiliation: Department of Epidemiology and Health Statistics, Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.
authors.forename: Hong
authors.initials: H
authors.lastname: Yan
mesh_terms: D000328:Adult; D003710:Demography; D017707:Erythrocyte Transfusion; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D019934:International Normalized Ratio; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D011517:Prothrombin Time; D012044:Regression Analysis; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D005340:Fibrinogen