Primary hemostasis after massive transfusion for injury.

Primary hemostasis, the formation of a platelet plug, was studied in 22 injured patients receiving an average of 21 transfusions during the operation for control of bleeding. The storage age of the blood averaged 15 days; no platelet transfusions were given. Platelet counts (PLT) and bleeding time (BT) were studied intraoperatively; postoperatively at 6 hours, 25 hours, day 2, day 4; and during convalescence (8 days to 3 months). Serial PLT and BT levels were correlated with the number of transfusions and age of blood. During operation, the PLT fell to 109,000/mm3 and the BT was greater than 15 minutes. Thrombocytopenia did not correlate with the number of transfusions or age of blood. The PLT averaged 106,000/mm3 at 6 hours and then fell significantly to 73,000/mm3 at 15 hours and to 76,000/mm3 on day 2. The PLT rose significantly to 110,000/mm3 by day four and increased to supernormal levels by convalescence. The BT remained elevated at 6 hours, 15 hours, day 2, and day 4, and declined to normal by convalescence. Thrombocytopenia and prolonged BT after massive transfusion for injury indicate platelet dysfunction which may protect against disseminated intravascular coagulation. Correction of the thrombocytopenia should be reserved for patients with bleeding.