Assessing response to changing plasma/red cell ratios in a bleeding trauma patient

• Published in: The American journal of emergency medicine 2010, Vol.28 (1), p.120.e1-120.e5
• Main Authors: Tien, Homer C., MD, MSc, Scarpellini, Sandro, MD, PhD, Callum, Jeannie, MD, Tremblay, Lorraine, MD, PhD, Rizoli, Sandro, MD, PhD
• Format: Article
• Language: English
• Subjects: Abdomen; Blood Coagulation Disorders - diagnosis; Blood Coagulation Disorders - etiology; Blood Coagulation Disorders - therapy; Blood Coagulation Tests; Blood Component Transfusion - methods; Blood platelets; Casualties; Emergency; Emergency medical care; Erythrocyte Transfusion; Fatal Outcome; Hemorrhage; Hemorrhage - etiology; Hemorrhage - therapy; Humans; Mathematical models; Pelvis; Plasma; Ratios; Wounds, Gunshot - complications; Wounds, Gunshot - therapy
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2009.04.027

Abstract Recent military experience suggests that transfusing fresh frozen plasma and packed red cells in a 1:1 ratio may improve survival in exsanguinating trauma patients. We report the case of a single patient who required massive transfusion after suffering a single gunshot wound. Initially, the patient received FFP:PRBC in 1:2 ratio, but this did not correct laboratory parameters except for INR and clotting factor VII level, which were likely normalized by treatment with recombinant activated factor VII. After receiving FFP:PRBC in a 4:5 ratio, he continued to bleed and his coagulation profile showed no appreciable improvement. In the final phase, he received FFP:PRBC in a 7:5 ratio and his laboratory parameters of coagulopathy normalized, except for factor V level which was improved. He also clinically stopped bleeding.