Transfusion massive et coagulopathie-: physiopathologie et implications cliniques

Jean-François Hardy; Philippe de Moerloose; Charles Marc Samama

doi:10.1007/BF03022251

. 2006;53(Suppl 2):S40. [Article in French] doi: 10.1007/BF03022251

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Transfusion massive et coagulopathie-: physiopathologie et implications cliniques

Jean-François Hardy ^1,^2,^3,^✉, Philippe de Moerloose ^4,^✉, Charles Marc Samama ^5,^✉

PMCID: PMC7103890 PMID: 16766790

Abstract

Purpose

To review the pathophysiology of coagulopathy in massively transfused, adult and previously hemostatically competent patients in both elective surgical and trauma settings, and to recommend the most appropriate treatment strategies.

Methods

Medline was searched for articles on “massive transfusion,” “transfusion,” “trauma,” “surgery,” “coagulopathy” and “hemostatic defects.” A group of experts reviewed the findings.

Principal findings

Coagulopathy will result from hemodilution, hypothermia, the use of fractionated blood products and disseminated intravascular coagulation. The clinical significance of the effects of hydroxyethyl starch solutions on hemostasis remains unclear. Maintaining a normal body temperature is a first-line, effective strategy to improve hemostasis during massive transfusion. Red cells play an important role in coagulation and hematocrits higher than 30% may be required to sustain hemostasis. In elective surgery patients, a decrease in fibrinogen concentration is observed initially while thrombocytopenia is a late occurrence. In trauma patients, tissue trauma, shock, tissue anoxia and hypothermia contribute to the development of disseminated intravascular coagulation and microvascular bleeding. The use of platelets and/or fresh frozen plasma should depend on clinical judgment as well as the results of coagulation testing and should be used mainly to treat a clinical coagulopathy.

Conclusions

Coagulopathy associated with massive transfusion remains an important clinical problem. It is an intricate, multifactorial and multicellular event. Treatment strategies include the maintenance of adequate tissue perfusion, the correction of hypothermia and anemia, and the use of hemostatic blood products to correct microvascular bleeding.

Objectif

Revoir la physiopathologie de la coagulopathie chez les adultes transfusés massivement et auparavant compétents sur le plan hémostatique, à la fois dans le contexte ďune intervention chirurgicale réglée ou à la suite ďun traumatisme. Recommander les stratégies thérapeutiques les plus appropriées.

Méthode

Dans Medline, nous avons cherché les articles traitant de “massive transfusion,” “transfusion,” “trauma,” “surgery,”“coagulopathy” et “hemostatic defects.” Un groupe ďexperts a examiné les résultats.

Constatations principales

La coagulopathie résulte de ľhémodilution, ľhypothermie, ľusage de produits sanguins fractionnés et la coagulation intravasculaire disséminée. La portée clinique des effets des solutions ďhydroxyéthyl-amidon sur ľhémostase n’est toujours pas claire. Le maintien ďune température corporelle normale est une stratégie de première intention efficace pour améliorer ľhémostase pendant la transfusion massive. Les globules rouges sont importants dans la coagulation et des hématocrites supérieurs è 30 % pourraient être nécessaires à une hémostase adéquate. Chez les patients en chirurgie réglée, une baisse de la concentration de fibrinogène est observée précocement tandis que la thrombocytopénie est plus tardive. Chez les traumatisés, le trauma tissulaire, le choc, ľanoxie et ľhypothermie tissulaires contribuent au développement ďune coagulation intravasculaire disséminée et du saignement microvasculaire. Ľutilisation de plaquettes et/ou de plasma frais congelé dépendra du jugement du clinicien ainsi que des résultats des tests de coagulation. La transfusion devra surtout viser le traitement ďune coagulopathie clinique (saignement microvasculaire).

Conclusion

La coagulopathie associée à la transfusion massive demeure un important problème clinique. C’est un événement complexe, multifactoriel et multicellulaire. Le traitement comprend le maintien ďune perfusion tissulaire adéquate, la correction de ľhypothermie et de ľanémie et ľusage de produits sanguins hémo-statiques pour corriger le saignement microvasculaire.

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PERMALINK

Transfusion massive et coagulopathie-: physiopathologie et implications cliniques

Massive transfusion and coagulopathy: pathophysiology and implications for clinical management

Jean-François Hardy

Philippe de Moerloose

Charles Marc Samama

Abstract

Purpose

Methods

Principal findings

Conclusions

Objectif

Méthode

Constatations principales

Conclusion

References

ACTIONS

PERMALINK

RESOURCES

Cite

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PERMALINK

Transfusion massive et coagulopathie-: physiopathologie et implications cliniques

Massive transfusion and coagulopathy: pathophysiology and implications for clinical management

Jean-François Hardy

Philippe de Moerloose

Charles Marc Samama

Abstract

Purpose

Methods

Principal findings

Conclusions

Objectif

Méthode

Constatations principales

Conclusion

References

ACTIONS

PERMALINK

RESOURCES

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