Patient Blood Management Guidelines: Module 1

Critical Bleeding Massive Transfusion

| Introduction |

1 Introduction

Patient blood management aims to improve clinical outcomes by avoiding unnecessary exposure to blood components. It includes the three pillars of:
  • optimisation of blood volume and red cell mass
  • minimisation of blood loss
  • optimisation of the patient’s tolerance of anaemia.

These principles apply in the management of any haematological disorder. Patient blood management optimises the use of donor blood and reduces transfusion-associated risk.

If blood components are likely to be indicated, transfusion should not be a default decision. Instead, the decision on whether to transfuse should be carefully considered, taking into account the full range of available therapies, and balancing the evidence for efficacy and improved clinical outcome against the potential risks.

This document, Patient Blood Management Guidelines: Module 1 – Critical Bleeding/Massive Transfusion, is the first in a series of six modules that focus on evidence-based patient blood management. The other five modules are listed in Table 1.1, below. Together, the six modules will replace the 2001 National Health and Medical Research Council/Australasian Society of Blood Transfusion (NHMRC/ASBT) Clinical practice guidelines on the use of blood components.1

This document is intended to assist and guide health-care professionals in making clinical decisions when managing patients with critical bleeding who require, or are likely to require, massive transfusion. Transfusion decisions for patients should also take into account each individual’s clinical circumstances and physiological status, and their treatment preferences and choices.

Revision of the 2001 guidelines1 was needed because of:

  • increasing evidence of transfusion-related adverse outcomes, leading to the emergence of new practices, including restrictive transfusion strategies and the increased use of alternatives to transfusion in the management of anaemia
  • variable (and frequently poor) compliance with the recommendations of the 2001 guidelines, indicated by a high degree of variation in transfusion practices
  • failure of the 2001 guidelines to address a range of clinical settings where blood management is commonly required, including critical bleeding and massive transfusion, chronic medical conditions, obstetrics and paediatrics.

Definitions (see Chapter 3.1)

‘Critical bleeding’ may be defined as major haemorrhage that is life threatening and likely to result in the need for massive transfusion.

‘Massive transfusion’ may be defined:

  • in adults, as a transfusion of half of one blood volume in 4 hours, or more than one blood volume in 24 hours (adult blood volume is approximately 70 mL/kg)
  • in children, as a transfusion of more than 40 mL blood/kg (blood volume of children older than neonates is approximately 80 mL/kg).