Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1986 Jan;203(1):40–48. doi: 10.1097/00000658-198601000-00008

Prophylactic platelet administration during massive transfusion. A prospective, randomized, double-blind clinical study.

R L Reed 2nd, D Ciavarella, D M Heimbach, L Baron, E Pavlin, R B Counts, C J Carrico
PMCID: PMC1251037  PMID: 3510591

Abstract

Prior studies at Harborview Medical Center have suggested that dilutional thrombocytopenia is a major etiology of microvascular, nonmechanical bleeding (MVB). We undertook a prospective randomized double-blind clinical study to compare the prophylactic effects of 6 units of platelet concentrates (PLT) versus 2 units of fresh frozen plasma (FFP) administered with every 12 units of modified whole blood in patients undergoing massive transfusion (12 or more units in 12 hours). After exclusions, three of 17 patients who received PLT and three of 16 patients who received FFP developed MVB, an incidence no different from our previous findings. Regression lines of platelet counts during transfusion were no different between groups, and both groups had higher platelet counts than predicted from a standard washout equation. Only one patient had evidence of dilutional thrombocytopenia as a cause for MVB. Prophylactic platelet administration is not warranted as a routine measure to prevent MVB.

Full text

PDF
44

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Attar S., Boyd D., Layne E., McLaughlin J., Mansberger A. R., Cowley R. A. Alterations in coagulation and fibrinolytic mechanisms in acute trauma. J Trauma. 1969 Nov;9(11):939–965. doi: 10.1097/00005373-196911000-00004. [DOI] [PubMed] [Google Scholar]
  2. Brodsky I., Dennis L. H. Evaluation of fibrinolysis in hepatic cirrhosis. Relation of serial thrombin time and euglobulin lysis time. Am J Clin Pathol. 1966 Jan;45(1):61–69. doi: 10.1093/ajcp/45.1.61. [DOI] [PubMed] [Google Scholar]
  3. Bull B. S., Schneiderman M. A., Brecher G. Platelet counts with the Coulter counter. Am J Clin Pathol. 1965 Dec;44(6):678–688. doi: 10.1093/ajcp/44.6.678. [DOI] [PubMed] [Google Scholar]
  4. CLAUSS A. Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens. Acta Haematol. 1957 Apr;17(4):237–246. doi: 10.1159/000205234. [DOI] [PubMed] [Google Scholar]
  5. Clagett G. P., Olsen W. R. Non-mechanical hemorrhage in severe liver injury. Ann Surg. 1978 Apr;187(4):369–374. doi: 10.1097/00000658-197804000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Collins J. A. Problems associated with the massive transfusion of stored blood. Surgery. 1974 Feb;75(2):274–295. [PubMed] [Google Scholar]
  7. Counts R. B., Haisch C., Simon T. L., Maxwell N. G., Heimbach D. M., Carrico C. J. Hemostasis in massively transfused trauma patients. Ann Surg. 1979 Jul;190(1):91–99. doi: 10.1097/00000658-197907000-00020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Davies J. W., Ricketts C. R., Bull J. P. Studies of plasma protein metabolism. 3. Fibrinogen in burned patients. Clin Sci. 1966 Apr;30(2):305–314. [PubMed] [Google Scholar]
  9. Filip D. J., Aster R. H. Relative hemostatic effectiveness of human platelets stored at 4 degrees and 22 degrees C. J Lab Clin Med. 1978 Apr;91(4):618–624. [PubMed] [Google Scholar]
  10. Goodnight S. H., Kenoyer G., Rapaport S. I., Patch M. J., Lee J. A., Kurze T. Defibrination after brain-tissue destruction: A serious complication of head injury. N Engl J Med. 1974 May 9;290(19):1043–1047. doi: 10.1056/NEJM197405092901903. [DOI] [PubMed] [Google Scholar]
  11. HOWLAND W. S., SCHWEIZER O., BOYAN C. P., DOTTO A. C. Physiologic alterations with massive blood replacement. Surg Gynecol Obstet. 1955 Oct;101(4):478–482. [PubMed] [Google Scholar]
  12. Harker L. A., Finch C. A. Thrombokinetics in man. J Clin Invest. 1969 Jun;48(6):963–974. doi: 10.1172/JCI106077. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Harker L. A., Slichter S. J., Sauvage L. R. Platelet consumption by arterial prostheses: the effects of endothelialization and pharmacologic inhibition of platelet function. Ann Surg. 1977 Nov;186(5):594–601. doi: 10.1097/00000658-197711000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. JACOBSSON K. I. Studies on the determination of fibrinogen in human blood plasma. II. Studies on the trypsin and plasmin inhibitors in human blood serum. Scand J Clin Lab Invest. 1955;7 (Suppl 14):3–102. [PubMed] [Google Scholar]
  15. KELEMEN E., LEHOCZKY D., CSERHATI I., KRIZSA F., RAK K. Demonstrability of a serum factor inducing thrombocytosis prior to acute rises of platelets in mice and men. Acta Haematol. 1963;29:16–26. doi: 10.1159/000207321. [DOI] [PubMed] [Google Scholar]
  16. KREVANS J. R., JACKSON D. P. Hemorrhagic disorder following massive whole blood transfusions. J Am Med Assoc. 1955 Sep 17;159(3):171–177. doi: 10.1001/jama.1955.02960200017004. [DOI] [PubMed] [Google Scholar]
  17. Marsaglia G., Thomas E. D. Mathematical consideration of cross circulation and exchange transfusion. Transfusion. 1971 Jul-Aug;11(4):216–219. doi: 10.1111/j.1537-2995.1971.tb04404.x. [DOI] [PubMed] [Google Scholar]
  18. Miller R. D., Robbins T. O., Tong M. J., Barton S. L. Coagulation defects associated with massive blood transfusions. Ann Surg. 1971 Nov;174(5):794–801. doi: 10.1097/00000658-197111000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. PROCTOR R. R., RAPAPORT S. I. The partial thromboplastin time with kaolin. A simple screening test for first stage plasma clotting factor deficiencies. Am J Clin Pathol. 1961 Sep;36:212–219. doi: 10.1093/ajcp/36.3.212. [DOI] [PubMed] [Google Scholar]
  20. RATNOFF O. D., MENZIE C. A new method for the determination of fibrinogen in small samples of plasma. J Lab Clin Med. 1951 Feb;37(2):316–320. [PubMed] [Google Scholar]
  21. Slichter S. J., Counts R. B., Henderson R., Harker L. A. Preparation of cryoprecipitated factor VIII concentrates. Transfusion. 1976 Nov-Dec;16(6):616–626. doi: 10.1046/j.1537-2995.1976.16677060245.x. [DOI] [PubMed] [Google Scholar]
  22. Slichter S. J., Funk D. D., Leandoer L. E., Harker L. A. Kinetic evaluation of haemostasis during surgery and wound healing. Br J Haematol. 1974 May;27(1):115–125. doi: 10.1111/j.1365-2141.1974.tb06779.x. [DOI] [PubMed] [Google Scholar]
  23. Slichter S. J., Harker L. A. Preparation and storage of platelet concentrates. I. Factors influencing the harvest of viable platelets from whole blood. Br J Haematol. 1976 Nov;34(3):395–402. doi: 10.1111/j.1365-2141.1976.tb03586.x. [DOI] [PubMed] [Google Scholar]
  24. Slichter S. J. Identification & management of defects in platelet hemostasis in massively transfused patients. Prog Clin Biol Res. 1982;108:225–258. [PubMed] [Google Scholar]
  25. Wallenstein S., Zucker C. L., Fleiss J. L. Some statistical methods useful in circulation research. Circ Res. 1980 Jul;47(1):1–9. doi: 10.1161/01.res.47.1.1. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES