Use of blood and blood products in trauma.

According to the global study of the burden of disease, violence and accidental injury account for 12% of deaths worldwide; 30-40% of trauma mortality is attributable to haemorrhage. The highly complex haemostatic system is severely impaired as a result of haemorrhagic shock, acidosis, hypothermia, haemodilution, hyperfibrinolysis, and consumption of clotting factors. Thus it is important to prioritize the prevention of the development of coagulopathy. Timely transfusion of red blood cells and plasma products becomes essential to restore tissue oxygenation, support perfusion, and maintain the pool of active haemostatic factors. The limits to this strategy to compensate for the loss of blood and coagulation factors are discussed. In the absence of international guidelines, there is an ongoing debate about a generally accepted treatment algorithm, mass transfusion protocols, and adverse events that have been observed as a result of transfusion. Thus many recommendations are based upon expert opinion rather than on evidence. In this chapter we address key issues of transfusions of red blood cells and plasma products in the acute control of bleeding in traumatized patients.