Transfusions in Trauma

1.  When should a transfusion be administered in the trauma patient?

• The answer to this question is controversial. 
  • Classically a transfusion for acute blood loss in the dog or cat has been advocated when the following parameters were seen:
    • Packed cell volume < 20% or total solids (protein) < 50% of the beginning value.
  • Today it is believed one should transfuse earlier to improve oxygen consumption (VO2) and thus survival.

 
VO2 = the rate of oxygen taken up from the systemic microcirculation
CO = Cardiac Output
Hgb = Hemoglobin Concentration (gm/dl)
Sao2 = oxygen concentration in arterial blood
Svo2 = oxygen concentration in venous blood

In order to maximize VO2, one must maximize CO, Hgb, and provide oxygen.
It appears more likely that a PCV > 30% (Hgb > 10 gm/dl) may be more useful in acute blood loss.

2.  How much blood should you administer in an acute blood loss?

• Ideally, the amount of blood given should closely match the amount lost.

• The following formula is useful in predicting how much blood may be required:

1 ml per 1 pound will raise the PCV by 1%

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