Haemorrhage
 |
Control of acute blood loss should prevent the development of haemostatic failure.
Restore circulating fluid volume to correct hypoperfusion.
The need for transfusion depends on:
-
the estimated loss of circulating blood volume, and
- the patient’s ability to compensate for the quantity of blood lost.
Blood volume can be estimated as approximately 70 mL/kg for adults, 80 mL/kg in children and 100 mL/kg in neonates.
| Guidelines for the Need for Transfusion in Response to Acute Blood Loss* (1) | ||
|
% loss of blood volume |
Volume (mL) in an adult |
Action |
| 15% | 750 mL | You do not need to transfuse unless blood loss is superimposed on pre-existing anaemia, or when the patient is unable to compensate for this quantity of blood loss because of severe cardiac or respiratory disease. |
| 15%–30% | 750–1500 mL |
You need to transfuse crystalloids or synthetic colloids. The need for red cells is unlikely unless the patient has a pre-existing anaemia, reduced cardiopulmonary reserve or if blood loss continues. |
| 30%–40% | 1500–2000 mL | Rapid volume replacement is required with crystalloids and synthetic colloids, and red cell transfusion will probably be required. |
| 40% | > 2000 mL | Rapid volume replacement including red cell transfusion is required. |
|
Note: *Based on estimation of lost circulating volume |
||
If bleeding continues after attempted surgical haemostasis and when the coagulation tests are abnormal or the platelet count reduced, then platelets, fresh frozen plasma, or cryoprecipitate or a combination of these products may also be required.
Clinical trials in humans have not demonstrated that albumin solutions or other colloids are superior to crystalloid in resuscitation, but much larger quantities of crystalloid are required.
The use of synthetic colloids such as dextrans and hydroxyethyl starch should be limited to 1.5 litres per 24 hours in adults.
Avoid saline in patients for whom sodium overload is a special risk. Care should be taken with Albumex® 4 for the same reason in these patients.
Specialist advice is recommended for the ongoing management.
Reference
- British Committee for Standards in Haematology. Guidelines on the Management of Massive Blood Loss. British Journal of Haematology 2006;135(5):634–641.
