From the Guidelines
The most common complications after massive blood transfusion include coagulopathy, hypothermia, hypocalcemia, hyperkalemia, acid-base disturbances, and transfusion reactions, with the correct answer being B. Coagulopathy hypocalcemia hyperkalemia hypothermia. The most recent and highest quality study 1 highlights the importance of monitoring and managing these complications to prevent morbidity and mortality. Some key points to consider:
- Coagulopathy occurs due to dilution of clotting factors and platelets as stored blood products lack these components, and patients typically need platelet transfusions when counts fall below 50,000/μL and fresh frozen plasma to replace clotting factors.
- Hypothermia develops when cold blood products lower core body temperature, requiring blood warmers during administration.
- Hypocalcemia results from citrate preservatives in blood products binding calcium; supplementation with calcium gluconate 1-2g IV may be necessary when symptoms or low levels occur, as recommended by 1 and 1.
- Hyperkalemia happens as stored red cells release potassium during storage; treatment includes calcium, insulin with glucose, or sodium bicarbonate for severe cases.
- Metabolic acidosis initially occurs from tissue hypoperfusion but may progress to metabolic alkalosis during recovery.
- Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are serious pulmonary complications requiring immediate recognition and supportive care, with TACO being the most common cause of transfusion-related mortality and major morbidity 1. Prevention strategies include:
- Following a balanced transfusion protocol (1:1:1 ratio of packed red cells, plasma, and platelets)
- Using blood warmers
- Monitoring electrolytes frequently
- Maintaining normothermia It is essential to prioritize these prevention strategies to minimize the risk of complications and improve patient outcomes, as supported by the evidence from 1, 1, and 1.
From the Research
Most Common Complications after Massive Blood Transfusion
The most common complications after massive blood transfusion include:
- Coagulopathy
- Hypothermia
- Acidosis
- Electrolyte abnormalities (hypocalcemia, hypomagnesemia, hypokalemia, hyperkalemia) 2, 3, 4, 5, 6
Specific Complications
Specific complications of massive blood transfusion are:
- Coagulopathy, which can be worsened by hypothermia and acidosis 4
- Hypothermia, which can occur due to the transfusion of cold blood products and can worsen coagulopathy 2, 3, 4, 5, 6
- Electrolyte abnormalities, such as hypocalcemia and hyperkalemia, which can occur due to the transfusion of large amounts of blood products 2, 3, 5, 6
Answer to the User's Question
Based on the evidence, the correct answer to the user's question is: B. Coagulopathy hypocalcemia hyperkalemia hypothermia 2, 3, 4, 5, 6