Massive transfusion may be defined as the acute administration of more than one and a half times of the patient´s estimated circulating volume.
Many of the problems associated with massive transfusion are due to the biologic changes of the stored? blood with preservation which eventually replace the most of the recipient´s -circulating blood.
In neurosurgical field, massive transfusion therapy is seldom necessary except in case of the operative intervention of meningioma, sinus rupture, aneurysm and large vessel injury from direct operative procedures. But the necessity of massive transfusion is getting increased recently with the improvement of neurosurgery and anestheology that permits the inoperable surgery in the past possible.
On these basis, this article presents the case summary of the 3 patients who received massive transfusion during neurosurgical procedures and the brief review of the problems and their possible mechanisms associated with massive transfusion.
The problems are acid-base disturbance, shift to the left of oxygen dissociation curve due to- the decrease of 2, 3-DPG, coagulopathy, shock lung and transmission of viral hepatitis through transfusion. To reduce these complication, the following managements will work well if properly handled.
1. Administer blood that is as fresh as possible. If available, prepare platelet concentrates.
2. Monitor platelet count, plasma fibrinogen level, partial thromboplastin time and cloth for lysis after every 5 to 10 pints of blood administered.
3. Analyze arterial blood for PaCO2, PaO2 and pH after every 5 pints of blood transfusion
to allow precise bicarbonate administration.
4. Monitor the EKG continuously to detect changes in potassium or calcium concentration and to correct immediately when indicated.
5. Warm all the blood before transfusion.
6. When the patient develops severe respiratory insufficiency with normocapneic hypoxemia
and diffuse homogenous density due to parenchymatous infiltration, in the chest roentgenogram, consider the situation as the establishment of shock lung and treat with artifical respirator and oxygen.
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