title: Survival after ultramassive transfusion: a review of 1360 cases.
abstract: Information about patient survival after transfusion of multiple blood volumes is limited, and most reports have focused on trauma patients.
  
  
  
  Retrospective study of blood use and survival at 11 hospitals in six nations between 2009 and 2013. Ultramassive transfusion (UMT) was defined as transfusion of 20 or more red blood cell (RBC) units over the course of any 2 consecutive calendar days.
  
  
  
  A total of 1975 patients received UMT and a representative sample of 1360 patients was studied in detail. Patients were grouped into seven diagnostic categories: solid organ transplantation (n = 411), cardiac or major vascular surgery (n = 317), general surgery (n = 228), trauma (n = 221), general medicine (n = 124), obstetrics (n = 23), and other (n = 36). During the 7 days after initiation of UMT, these patients used more than 120,000 blood components. The median (interquartile range) blood use was 35 (26-50) RBC units, 30 (20-47) plasma units, and 7 (4-13) platelet doses. Five- and 30-day survival significantly declined with increasing RBC use. Overall survivals of patients receiving UMT were 71% (5 day) and 60% (30 day), and in the subset of 165 patients receiving 60 or more RBC units over 2 consecutive days, 5-day survival was 54% ranging from 17% (trauma) to 75% (solid organ transplant). The decline in survival with increasing RBC transfusions was minimal for patients undergoing solid organ transplantation and was most pronounced for trauma and nonsurgical bleeding patients.
  
  
  
  Trauma was not the leading cause of UMT. Increasing RBC requirements were significantly associated with decreasing survival. However, survival was more strongly associated with diagnostic category than total RBCs transfused, with highest survival rates in solid organ transplant surgery.
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Walter Sunny
authors.initials: WS
authors.lastname: Dzik
authors.affiliation: Department of Pathology and Laboratory Medicine, Division of Transfusion Medicine, UCLA Medical Center, Los Angeles, California.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Ziman
authors.affiliation: Lab Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: Claudia
authors.initials: C
authors.lastname: Cohn
authors.affiliation: Medicine and Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Menaka
authors.initials: M
authors.lastname: Pai
authors.affiliation: Hemotherapy and Hemostasis, University Clinic Hospital, Barcelona, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Lozano
authors.affiliation: Pathology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Kaufman
authors.affiliation: Laboratory Medicine, University of Washington, and Puget Sound Blood Center, Seattle, Washington.
authors.forename: Meghan
authors.initials: M
authors.lastname: Delaney
authors.affiliation: Institut for Immunology and Transfusion Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Selleng
authors.affiliation: John Radcliffe Hospital, NHS Blood & Transplant, Oxford, UK.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Murphy
authors.affiliation: Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.
authors.forename: Tor
authors.initials: T
authors.lastname: Hervig
authors.affiliation: Institute for Transfusion Medicine, Pittsburgh, Pennsylvania.
authors.forename: Mark
authors.initials: M
authors.lastname: Yazer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D019737:Transplants / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy; D055815:Young Adult