Patient Blood Management Guidelines: Module 1

Critical Bleeding Massive Transfusion

| Future directions |

5.1 Evidence gaps and areas of future research

5.1.7 Effect of blood components on outcomes

Question 7 (interventional)

In patients with critical bleeding requiring massive transfusion, what is the effect of FFP, cryoprecipitate, fibrinogen concentrate, and/or platelet transfusion on patient outcomes?

FFP, fresh frozen plasma

This question clearly overlaps with question 2, which relates to the administration of RBC and component therapy according to ratios.

Some studies have demonstrated beneficial effects of the early use of component therapy in trauma patients. If early component therapy does help to control bleeding, the total RBC transfusion requirement would be reduced.

Further research is needed to investigate the effects of early use of component therapy in critically bleeding patients, through controlled studies that clearly define the indication or trigger for the administration of a particular component.

A challenge for studies in this clinical setting is the relative inability to control for the many variables that may contribute to ongoing bleeding. For example, early administration of component therapy may be futile if there has been no progress in the surgical control of bleeding. Conversely, in many situations it is almost impossible to differentiate between bleeding due to surgery and to haemostatic failure.