-Massive transfusion protocol - >10 units blood in 24 hours;

 Loss > 4U in one hour

 Blood loss >150ml/min with hemodynamic instability
 Other definitions as well
-goal of blood transfusion – o2 carrying capacity improvement (o2 carrying capacity = (hb x sao2
x 1.34) + .003*pao2). Inc Pao2 helps very little.

-type and screen – type blood and expose known antibodies

-screen: take plasma and test against known rbc with known Ag; look for agglutination (serum
has ab to one of antigens)
-type and cross: patient’s serum against donor rbc to check for agglutination

-dilutional coagulopathy – given lots of prbc without factors; important to avoid excessive
crystalloid
-1:2 is sufficient to prevent dilutional coagulopathy

-PCC: factor concentrate (II, VII, IX, X); no antithrombin

-r factor – clotting time (TEG)
-MA/MCF – clot strength made of platelets/fibrinogen

-TRICC trial hb 7 vs 10. Healthy pts did better at hb 7.

-leukoreduced – prevent non hemolytic reaction; multiparous women donors have the most
risk. CMV commonly prevented.
-irradiated blood – kills all white cells; not filtered like leukoreduced
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