Definitions of massive transfusion in adults with critical bleeding: a systematic review

Journal article

Introduction: Polytrauma is a well-established cause of death in young people and adults and its burden is a global public concern, with multiple organ failure being the most common cause of mortality. Transfusion medicine is an evolving specialty with transfusion interventions, especially for bleeding patients. The age and sex of the blood component donor can affect post-transfusion results. When analyzing data from 2018, it is estimated that violence and injuries represented 19.5% of all deaths in Brazil. Objective: To present, through a systematic review, the main considerations for the transfusion of blood components in polytrauma in intensive care units, considering different types of trauma and previous procedures to reduce the need for massive blood transfusion. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from February to April 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, with articles dated from 2011 to 2024. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 102 articles were found. A total of 37 articles were evaluated and 16 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 8 studies with a high risk of bias and 30 studies that did not meet GRADE. Most studies showed homogeneity in their results, with I2 =16.7%<25%. Transfusion of blood components is necessary in the resuscitation of patients with major trauma. However, packaged red blood cells and platelets break down and undergo chemical changes during storage (known as storage injury) that lead to an inflammatory response when the blood components are transfused into patients. Although some evidence supports a detrimental association between transfusion and a patient's outcome, the mechanisms linking transfusion of stored components to outcomes remain unclear. For the most complete care of massive transfusions, it is imperative to review the concepts of volume/perfusion and tissue oxygenation, as well as the difference between the concepts. Still, there appears to be little or no difference in harm between whole blood transfusion therapy and blood component therapy, based on small studies with very low certainty of evidence. The blood component donor's gender, but not age, may be an important factor associated with post-injury multiple organ failure

Authors: Lin, VS; Sun, E; Yau, S; Abeyakoon, C; Seamer, G

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BioMed Central
• Journal: Critical Care
• Volume: 27
• Issue: 1
• Pages: 265-265
• Article number: 265
• Publication date: 2023-07-05
• DOI: 10.1186/s13054-023-04537-z
• EISSN: 1364-8535
• ISSN: 1364-8535
• Language: English
• Keywords: Population; MEDLINE; Pediatrics; Randomized controlled trial; Systematic review; Internal medicine; Clinical trial; Intensive care medicine; Surgery; Medicine