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Postgraduate Education Corner: CONTEMPORARY REVIEWS IN CRITICAL CARE MEDICINE |

Complications of Massive Transfusion

Kristen C. Sihler, MD, MS; Lena M. Napolitano, MD
Author and Funding Information

From the University of Michigan School of Medicine, Ann Arbor, MI.

Correspondence to: Lena Napolitano MD, Department of Surgery, University of Michigan Health System, Room 1C421 University Hospital, 1500 East Medical Drive, Ann Arbor, MI 48109-0033; e-mail: lenan@umich.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(1):209-220. doi:10.1378/chest.09-0252
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Massive transfusion (MT) is a lifesaving treatment of hemorrhagic shock, but can be associated with significant complications. The lethal triad of acidosis, hypothermia, and coagulopathy associated with MT is associated with a high mortality rate. Other complications include hypothermia, acid/base derangements, electrolyte abnormalities (hypocalcemia, hypomagnesemia, hypokalemia, hyperkalemia), citrate toxicity, and transfusion-associated acute lung injury. Blood transfusion in trauma, surgery, and critical care has been identified as an independent predictor of multiple organ failure, systemic inflammatory response syndrome, increased infection, and increased mortality in multiple studies. Once definitive control of hemorrhage has been established, a restrictive approach to blood transfusion should be implemented to minimize further complications.

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