From the Guidelines
A large hematoma should be managed with immediate medical attention, focusing on stabilizing the patient and controlling bleeding, and the treatment strategy should include fibrinogen concentrate or cryoprecipitate and pRBC, or FFP or pathogen-inactivated FFP in a FFP/pRBC ratio of at least 1:2 as needed, as recommended by the most recent guidelines 1. In the management of a large hematoma, it is crucial to prioritize strategies that minimize morbidity, mortality, and improve quality of life. The European guideline on management of major bleeding and coagulopathy following trauma, sixth edition, published in 2023, provides the most recent and highest quality evidence for managing large hematomas 1. Key considerations in the treatment include:
- The use of fibrinogen concentrate or cryoprecipitate and pRBC, or FFP or pathogen-inactivated FFP in a FFP/pRBC ratio of at least 1:2 as needed, to manage expected massive hemorrhage 1.
- A high platelet/pRBC ratio is also suggested to support coagulation and minimize bleeding risk 1. It is essential to note that while other studies, such as the guidelines for the management of spontaneous intracerebral hemorrhage in adults from 2007, discuss endoscopic aspiration for supratentorial hemorrhage, this approach may not be directly applicable to all types of large hematomas and is not supported by the most recent and highest quality evidence 1. Therefore, the primary focus should be on the strategies outlined in the most recent guidelines to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life for patients with large hematomas.
From the Research
Diagnosis of Large Hematoma
- A large hematoma is a collection of blood outside of blood vessels, which can occur due to trauma or operative procedures 2
- The diagnosis of a large hematoma is typically based on symptoms such as swelling, pain, and bruising, as well as imaging studies like computed tomography (CT) scans 3, 4
- The location and size of the hematoma can also be assessed using imaging studies, which can help guide treatment decisions 5, 4
Treatment of Large Hematoma
- The treatment of a large hematoma typically involves prompt recognition and operative evacuation of the hematoma to prevent complications such as necrosis of the overlying skin and tissue ischemia 2
- In some cases, tranexamic acid may be used as an adjunct therapy to reduce bleeding and promote hemostasis 6
- For patients with traumatic brain injury and intracranial hematoma, emergent surgical evacuation may be necessary to prevent cerebral herniation and improve outcomes 3, 4
- In cases of expanding hematoma in the neck and face, aggressive airway management and emergency surgical intervention may be required to prevent airway compromise and other complications 5
Management of Complications
- Patients with large hematomas are at risk for complications such as bleeding, infection, and tissue necrosis, which require close monitoring and management 2, 3
- In cases of traumatic brain injury, patients may require intensive care and multidisciplinary management to achieve the best possible outcome 4
- The use of platelet transfusions and other blood products may be necessary in patients with preoperative thrombocytopenia or other coagulopathies 3