Management of Transfusion in Patients with Massive Intraoperative Bleeding

Abstract

This retrospective study was performed to investigate the use of blood products and the intra-and postoperative complications in 16 adult patients whose intraoperative blood loss exceeded 4, 000ml.
The following results were obtained. The starting point of blood product transfusion was when the blood loss was estimated to be around 1, 500ml for red blood cells, 4, 000ml for fresh-frozen plasma, and 8, 000ml for platelets. Large doses of plasma protein fraction were required to maintain normovolemic conditions and plasma oncotic pressure. The recently revised guidelines for the use of blood products published by the Japanese Ministry of Health and Welfare were usually valid, even in a surgical setting. Intraoperative myocardial ischemia due to hemodilution was seen in non-cardiac patients with a hematocrit less than 20%.
Further study to evaluate the safety of administering large doses of artificial colloidal plasma substitutes and the introduction of low cost recombinant human serum albumin to clinical practice is essential.