Blood Component Alternatives During Acute Hemorrhage

Transfusion of blood and blood components is a fundamental part of acute hemorrhage management. While fresh whole blood is ideal for its superior oxygen carrying capacity and clotting factor function, most resuscitations will involve its closest equivalents of either cold-stored whole blood or RBCs, plasma, and platelets in a 1:1:1 ratio. Other components that may be transfused include cryoprecipitate and fibrinogen concentrate. Coagulation adjuncts that may be given include prothrombin complex concentrate, tranexamic acid, and desmopressin. Transfusing blood products carries risks, including metabolic effects, hyperkalemia, coagulopathy, infection, transfusion reactions, and more. Coagulation status can be followed using viscoelastic testing such as thromboelastography or rotary thromboelastomerography. Massive transfusion protocols should include blood, empiric calcium, tranexamic acid, viscoelastic testing, and a designated organizer to guide resuscitation. After surgical hemostasis is achieved, topical adjuncts such as fibrin sealant and collagen fleece may help maintain hemostasis.