Which of the following is/are correct in patients receiving a massive blood transfusion for acute blood loss?
A. Packed red blood cells and the crystalloid solution should be infused to restore oxygen-carrying capacity and intravascular volume. B. Two units of FFP should be given with every 5 units of packed red blood cells in most cases C. A “six pack” of platelets should be administered with every 10 units of packed red blood cells in most cases. D. One to two ampules of sodium bicarbonate should be administered with every 5 units of packed red blood cells to avoid acidosis. E. One ampule of calcium chloride should be administered with every 5 units of packed red blood cells to avoid hypocalcemia.
Packed red blood cells and crystalloid solution should be infused to restore oxygen-carrying capacity and intravascular volume.-patients who are suffering from acute blood loss require crystalloid resuscitation as the initial maneuver to restore intravascular volume and re-establish vital signs. if 2 to 3 liters of crystalloid solution is inadequate to restore intravascular volume status, packed red blood cells should be infused as soon as possible. there is no role for prophylactic infusion of ffp, platelets, bicarbonate, or calcium to patients receiving massive blood transfusion. if specific indications exist patients should receive these supplemental components. in particular, patients who have abnormal coagulation tests and have ongoing bleeding should receive ffp. patients who have depressed platelet counts along with clinical evidence of oozing (microvascular bleeding) benefit from platelet infusion. sodium bicarbonate is not necessary, since most patients who receive blood transfusion ultimately develop alkalosis from the citrate contained in stored red blood cells. the use of calcium chloride is usually unnecessary unless the patient has depressed liver function, ongoing prolonged shock associated with hypothermia, or, rarely, when the infusion of blood proceeds at a rate exceeding 1 to 2 units every 5 minutes.