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Can patient blood management be applied in trauma survivors with massive bleeding?

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asked Jul 24, 2012 in Conditions and Treatments by Hatice Simsek MD (3,070 points)
edited Jul 24, 2012 by Jan B. Wade

3 Answers

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My opinion based on thorough reading of literature is that patient blood management can and should be applied in trauma survivors with massive bleeding if for no other reason than to lessen whatever blood product transfusion might be necessary to minimize morbidity and mortality. In the face of Hb levels <5-6g/dL clinicians should consider red cell transfusion as the mainstay response, and particularly so if bleeding persists.


Very good articles addressing this are:


Shander et al, What is really dangerous: anaemia or transfusion?, British Journal of Anaesthesia (S1): i41-I59 (2011)


Shander et al, Appropriateness of Allogeneic Red Blood Cell Transfusion: The International Consensus Conference on Transfusion Outcomes, Transfusion Medicine Reviews, Vol 25, No 3 (July), 2011: pp 232-246.e53
answered Jul 24, 2012 by anonymous
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As a patient who would not accept red cell transfusion, or any other blood-based treatment, I would certainly hope that the trauma team would immediately institute patient blood management. Pump me full of saline or whatever non-blood fluid available to keep my volume up, too. Respect my conscientous decision!
answered Jul 24, 2012 by nomoreviolins (220 points)
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Dr. Aryeh Shander - in an interview on PBS -' Blood Test: What you don't know about blood '  special from Aug 2010 was asked a similar question - Interviewer "At what point must you transfuse?"

Dr. Shander's reply " That is a hard question for me to answer. We have had patients go home who's blood count was below 2 gm/dl"  " Interviewer "Without blood?

Dr. Shander  "Without blood!"  and he had a big smile on his face.  One Patient came from another NJ hospital which tried to stop patient's transfer to Englewood-even to point of disconnecting life support. That hospital is now part of a bigger healthcare system with a PBM program.


Dr. Seiski from Allegheny General in greater Pittsburg area has had similar results - patients surviving with counts under 2 gm/dl when presented to him. Dr. Seiski is a woman's cancer surgeon. -July 25/11 interview available as mp3 on their website.


Jan 2010 ( air date in Feb. 2010 ) in a news discussion CaucusNJ show  'The Blood Option' ( can see video in 2 or 4 parts on Youtube - pnutts27 channel ) all 3 doctors Dr. Shander, Dr. L.T. Goodnough and Dr. Friedman all agreed that doctors and the public are not taught how to administer blood - Dr. Friedman even stating about  'the appropriateness of transfusing or not' and everybody needs to be educated about the dangers of blood transfusions.'

Dr. Goodnough- chief of transfusion medicine at Stanford U Hospital mentioned that in "Massive blood loss-blood may have indeed saved your life ( 1st 24 hours ) but the price you pay is complications ( after 24 hours - if you live longer  )

It is interesting that he mentioned the 1st 24 hours- if you die in that time frame they do not know if it is from the trauma or the blood transfusion. After 24 hours - dying is more apt to be from the blood.

Massive Transfusion Protocol has not shown benefit in civilian trauma patients - there is a 113 page document ( module one ) from US gov't on this


Thus PBM should be applied to trauma survivors who have massive bleeding -


Most things in the programs are available in most even small hospitals- after all - how did they cope in Haiti after the eartquake- they had no 'safe' blood or otherwise to transfuse. Haiti has very high rate of infection with HIV.  They used simple blood conservation methods

answered Jul 25, 2012 by pnutts (1,820 points)

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