Reflexoês sobre alfabetização

The Journal of Emergency Medicine, Vol. 39, No. 2, pp. 253–260, 2010 Copyright © 2010 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$–see front matter

doi:10.1016/j.jemermed.2009.02.034

Clinical Reviews

TRANSFUSION OF BLOOD PRODUCTS IN TRAUMA: AN UPDATE
Gustavo P. Fraga,
MD, PHD,*†

Vishal Bansal,

MD,*

and Raul Coimbra,

MD, PHD, FACS*

*Department of Surgery, Division of Trauma, Surgical Critical Care, and Burns, University of California San Diego, San Diego, California and †Division of Trauma Surgery, State University of Campinas, Campinas, Brazil Reprint Address: Raul Coimbra, MD, PHD, FACS, Division of Trauma/Department of Surgery, UCSD Medical Center, 200 W. Arbor Drive #8896, San Diego, CA 92103-8896

e Abstract—Background: Blood transfusion in the management of severely injured patients can be lifesaving. These patients are susceptible to developing early coagulopathy, thus perpetuating bleeding. Objectives: This article presents recent advances in both the civilian and military clinical arena to improve the treatment of trauma patients with severe hemorrhage, the use of agents to support coagulation, perspectives on restrictive transfusion strategies, and transfusion-related risks. Discussion: Massive blood transfusion is an adjunct to surgical care. The volume of blood products transfused and the ratio of blood components have been associated with increased morbidity and mortality rates. The adverse clinical effects of transfusion and the limited supply of blood products have resulted in modern resuscitation protocols to limit the volume of blood transfused. Conclusion: A restrictive blood transfusion strategy and the use of hemostatic agents may decrease morbidity and mortality in trauma patients, but insufficient data are available for their use in trauma patients. Massive transfusion should reflect an equal ratio of packed red cells and plasma to limit coagulopathy. Prospective randomized trials are needed to