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John R Hess - One of the best experts on this subject based on the ideXlab platform.
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Blood Component use and injury characteristics of acute trauma patients arriving from the scene of injury or as transfers to a large mature us level 1 trauma center serving a large geographically diverse region
Transfusion, 2021Co-Authors: Zhinan Liu, John R Hess, Rajiv C Ayyagari, Edison Martinez Y Monegro, Lynn G Stansbury, Saman Arbabi, Eileen M Bulger, Monica S VavilalaAbstract:BACKGROUND Advanced trauma care demands the timely availability of hemostatic Blood products, posing special challenges for regional systems in geographically diverse areas. We describe acute trauma Blood use by transfer status and injury characteristics at a large regional Level 1 trauma center. STUDY DESIGN AND METHODS We reviewed Harborview Medical Center (HMC) Trauma Registry, Transfusion Service, and electronic medical records on acute trauma patients for demographics, injury patterns, Blood use, and in-hospital mortality, 2011-2019. RESULTS Among 47,471 patients (mean age 45.2 ± 23.0 years; 68.3% male; Injury Severity Score 12.6 ± 11.1), 4.7% died and 8547 (18%) received at least one Blood Component through HMC. Firearms injuries were the most often transfused (690/2596, 26.6%) and the most urgently (39.9% ≥3 units in <1 h; 40.6% ≥5 units in <4 h), and had the highest mortality (case-fatality, 12.2%) (all p < .001). From-scene patients were younger than transfers (42.9 ± 21.0 vs. 47.2 ± 24.4), predominated among firearms injuries (68.2% from-scene vs. 31.8% transfers), were more likely to receive Blood (18.5% vs. 17.6%) more urgently (≥3 units first hour, 24.4% vs. 7.7%; ≥5 units first 4 h: 25.6% vs. 8.2%), were more likely to die of hemorrhage (15.5% vs. 4.3%) and from firearms injuries (310/1360, 22.8%) (all p < .001). DISCUSSION Early Blood use, firearms injuries, and mortality were all greater among from-scene patients, and firearms injuries had worse outcomes despite greater and more urgent Blood use, but the role of survivor bias for transfer patients must be clarified. Future research must identify strategies for providing local hemostatic transfusion support, particularly for firearms injuries.
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association of Blood Component ratios with 24 hour mortality in injured children receiving massive transfusion
Critical Care Medicine, 2019Co-Authors: Lynn G Stansbury, Saman Arbabi, Eileen M Bulger, Monica S Vavilala, Elissa K Butler, Brianna Mills, Jonathan I Groner, John R HessAbstract:Objectives:To determine if higher fresh frozen plasma and platelet to packed RBC ratios are associated with lower 24-hour mortality in bleeding pediatric trauma patients.Design:Retrospective cohort study using the Pediatric Trauma Quality Improvement Program Database from 2014 to 2016.Setting:Level
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massive transfusion in cardiac surgery the impact of Blood Component ratios on clinical outcomes and survival
Anesthesia & Analgesia, 2017Co-Authors: Meghan Delaney, Darrell J. Triulzi, Paul Stark, Minhyung Suh, John R Hess, Marie E Steiner, Christopher P Stowell, Steven R SloanAbstract:Background Cardiac surgery is the most common setting for massive transfusion in medically advanced countries. Studies of massive transfusion after injury suggest that the ratios of administered plasma and platelets (PLT) to red Blood cells (RBCs) affect mortality. Data from the Red Cell Storage Duration Study (RECESS), a large randomized trial of the effect of RBC storage duration in patients undergoing complex cardiac surgery, were analyzed retrospectively to investigate the association between Blood Component ratios used in massively transfused patients and subsequent clinical outcomes. Methods Massive transfusion was defined as those who had ≥6 RBC units or ≥8 total Blood Components. For plasma, high ratio was defined as ≥1 plasma unit:1 RBC unit. For PLT transfusion, high ratio was defined as ≥0.2 PLT doses:1 RBC unit; PLT dose was defined as 1 apheresis PLT or 5 whole Blood PLT equivalents. The clinical outcomes analyzed were mortality and the change in the Multiple Organ Dysfunction Score (ΔMODS) comparing the preoperative score with the highest composite score through the earliest of death, discharge, or day 7. Outcomes were compared between patients transfused with high and low ratios. Linear and Cox regression were used to explore relationships between predictors and continuous outcomes and time to event outcomes. Results A total of 324 subjects met the definition of massive transfusion. In those receiving high plasma:RBC ratio, the mean (SE) 7- and 28-day ΔMODS was 1.24 (0.45) and 1.26 (0.56) points lower, (P = .007 and P = .024), respectively, than in patients receiving lower ratios. In patients receiving high PLT:RBC ratio, the mean (SE) 7- and 28-day ΔMODS were 1.55 (0.53) and 1.49 (0.65) points lower (P = .004 and P = .022), respectively. Subjects who received low-ratio plasma:RBC transfusion had excess 7-day mortality compared with those who received high ratio (7.2% vs 1.7%, respectively, P = .0318), which remained significant at 28 days (P = .035). The ratio of PLT:RBCs was not associated with differences in mortality. Conclusions This analysis found that in complex cardiac surgery patients who received massive transfusion, there was an association between the composition of Blood products used and clinical outcomes. Specifically, there was less organ dysfunction in those who received high-ratio transfusions (plasma:RBCs and PLT:RBCs), and lower mortality in those who received high-ratio plasma:RBC transfusions.
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modelling the effects of Blood Component storage lesions on the quality of haemostatic resuscitation in massive transfusion for trauma
Vox Sanguinis, 2017Co-Authors: James A Mays, John R HessAbstract:BACKGROUND: All Blood Components undergo loss of potency during storage. These loss-of-potency storage lesions are important in trauma resuscitation because they reduce the haemostatic capacity of mixtures of Components that attempt to reconstitute whole Blood. Even red cell storage-related loss of potency, which averages 17% with modern additive solutions, is important because 6 units of red cells must be given to achieve the effect of 5 fully potent units. MATERIALS AND METHODS: Loss of potency of stored units of red Blood cells, plasma, platelets, and cryoprecipitate were summed for dilutional, storage-related, pathogen reduction-related, and splenic sequestration-related causes and expressed as fractional plasma coagulation factor concentrations and platelet counts. RESULTS: Production of reconstituted whole Blood from 1:1:1 unit ratios of red cells:plasma:platelets is associated with a 38% loss of plasma coagulation factor concentration and 56% loss of platelets. Storage losses of 17% for red cells, 10% for coagulation factors, and 30% for platelets are additive to pathogen reduction-related losses of 18% for coagulation factors and 30% for platelets. DISCUSSION: Component preparation and storage-related losses of potency for all Blood Components are serious problems for trauma resuscitation. Even red cell storage contributes to this problem and this can be made better in ways that can save many lives each year.
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the association of Blood Component use ratios with the survival of massively transfused trauma patients with and without severe brain injury
Journal of Trauma-injury Infection and Critical Care, 2011Co-Authors: Philip C Spinella, Charles E Wade, Lorne H Blackbourne, Matthew A Borgman, Lee A Zarzabal, Jeremy G Perkins, M Maegele, Martin A Schreiber, John R HessAbstract:Abstract : Background: The effect of Blood Component ratios on the survival of patients with traumatic brain injury (TBI) has not been studied. Methods: A database of patients transfused in the first 24 hours after admission for injury from 22 Level I trauma centers over an 18-month period was queried to find patients who (1) met different definitions of massive transfusion (5 units red Blood cell [RBC] in 6 hours vs. 10 units RBC in 24 hours), (2) received high or low ratios of platelets or plasma to RBC units (1:2 vs. /=1:2), and (3) had severe TBI (head abbreviated injury score /=3) (TBI+). Results: Of 2,312 total patients, 850 patients were transfused with /= 5 RBC units in 6 hours and 807 could be classified into TBi+ (n = 281) or TBI- (n = 526). Six hundred forty-three patients were transfused with /=10 RBC units in 24 hours with 622 classified into TBI+ (n = 220) and TBi- (n = 402). For both high-risk populations, a high ratio of platelets:RBCs (not plasma) was independently associated with improved 30-day survival for patients with TBI+ and a high ratio of plasma:RBCs (not platelets) was independently associated with improved 30-day survival in TBI- patients. Conclusions: High platelet ratio was associated with improved survival in TBI+ patients while a high plasma ratio was associated with improved survival in TBI- patients. Prospective studies of Blood product ratios should include TBI in the analysis for determination of optimal use of ratios on outcome in injured patients.
Steven M Frank - One of the best experts on this subject based on the ideXlab platform.
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balancing the Blood Component transfusion ratio for high and ultra high dose cell salvage cases
Journal of Cardiothoracic and Vascular Anesthesia, 2021Co-Authors: Kevin R Merkel, Eric A. Gehrie, Steven M Frank, Nadia B Hensley, Sophia Lin, Tymoteusz J Kajstura, Nicolas C Cruz, James H Black, Brian C ChoAbstract:Objective To assess the ratio of non-red Blood cell to red Blood cell Components required to avoid coagulopathy when transfusing large amounts of salvaged Blood using laboratory test–guided therapy. Design Retrospective cohort study. Setting Single-center, academic hospital. Participants Thoracoabdominal and abdominal open aortic surgery patients. Measurement and Main Results Thirty-eight patients in whom at least 1,000 mL of salvaged red Blood cells were transfused were identified and divided into the following 2 cohorts: 1,000-to-2,000 mL of salvaged red Blood cells (high dose) (n = 20) and >2,000 mL of salvaged red Blood cells (ultra-high dose) (n = 18). Compared with the high-dose cohort, the ultra high-dose cohort received ∼4 times more salvaged red Blood cells (1,240 ± 279 mL v 5,550 ± 3,801 mL). With transfusion therapy guided by intraoperative coagulation tests and thromboelastography, the adjusted ratio of non-red Blood cell to red Blood cell Components (plasma + platelets + cryoprecipitate:allogeneic + salvaged red Blood cells) was 0.59 ± 0.66 in the high-dose and 0.93 ± 0.27 in the ultra high-dose cohorts. Multiple coagulation parameters were normal and similar between cohorts at the end of surgery, as determined by the mean, median, and 95% confidence intervals. Conclusions When transfusing large volumes of salvaged Blood, it is important to balance the ratio between non-red Blood cell and red Blood cell Components. Through a laboratory test–guided approach, coagulopathy was not detected when transfusing Blood in ratios of approximately 1:2 for patients receiving 1,000-to-2,000 mL of salvaged Blood and 1:1 for patients receiving >2,000 mL of salvaged Blood.
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Blood utilization and clinical outcomes in extracorporeal membrane oxygenation patients
Anesthesia & Analgesia, 2020Co-Authors: Caroline X Qin, Steven M Frank, Kevin R Merkel, Lekha V Yesantharao, Dheeraj Goswami, Alejandro V Garcia, Glenn J R Whitman, Melania M BembeaAbstract:BACKGROUND Patients requiring extracorporeal membrane oxygenation (ECMO) support are critically ill and have substantial transfusion requirements, which convey both risks and benefits. A retrospective analysis was conducted to assess the association between Blood Component administration and adverse outcomes in adult, pediatric, and neonatal ECMO patients. METHODS We evaluated 217 ECMO patients at a single center hospitalized between January 2009 and June 2016. Three cohorts (88 adult, 57 pediatric, and 72 neonatal patients) were included for assessment of patient characteristics, Blood utilization, and clinical outcomes. Univariable and multivariable analyses were used to assess the association between transfusions and clinical outcomes (primary outcome: mortality and secondary outcomes: morbid events). The analysis included the main exposure of interest (total number of Blood Component units transfused) and potential confounding variables (age group cohort, case mix index, sex, ECMO mode and duration, and primary ECMO indication). RESULTS After adjustment for confounders, with each additional Blood Component unit transfused, there was an estimated increase in odds for mortality by 1% (odds ratio [OR] = 1.01; 95% confidence interval [CI], 1.00-1.02; P = .013) and an increase in odds for thrombotic events by 1% (OR = 1.01; 95% CI, 1.00-1.02; P = .007). Mortality was higher in the adult (57 of 88; 64.8%) and pediatric (37 of 57; 64.9%) than in the neonatal cohort (19 of 72; 26.4%) (P < .0001). Median total Blood Components transfused per day followed a similar pattern for the adult (2.3 units; interquartile range [IQR] = 0.8-7.0), pediatric (2.9 units; IQR = 1.1-10), and neonatal (1.0 units; IQR = 0.7-1.6) cohorts (P < .0001). Over the entire hospitalization, the total median Blood Components transfused was highest in the neonatal (41 units; IQR = 24-94) and pediatric (41 units; IQR = 17-113) compared to the adult (30 units; IQR = 9-58) cohort (P = .007). There was no significant interaction between total units transfused over the hospital stay and age cohort for mortality (P = .35). CONCLUSIONS Given the association between transfusion and adverse outcomes, effective Blood management strategies may be beneficial in ECMO patients.
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how do i audit intraoperative Blood Component utilization in cardiac surgery
Transfusion, 2019Co-Authors: Nadia B Hensley, Steven M Frank, Brian C Cho, Mereze Visagie, Laeben Lester, James H AbernathyAbstract:BACKGROUND Patient Blood management programs are tasked with auditing transfusions for appropriateness; however, cardiac surgical programs have high variability in Blood utilization. After benchmarking intraoperative Blood utilization as higher than expected, we devised effective methods for audits with feedback to the cardiac anesthesiologists that are described in this report. STUDY DESIGN AND METHODS Red Blood cell (RBC), plasma, platelet (PLT), and cryoprecipitate transfusion data were collected from the electronic record system for 2242 patients having cardiac surgery from July 2016 until July 2018. In July 2017, we performed audits with feedback using rank-order bar graphs displayed on the anesthesiology office door for intraoperative Blood utilization. Individual providers were compared to their peers for all four major Blood Components, with the goal of improving practice by reducing variability. RESULTS After the audits with feedback, the intraoperative mean units/patient decreased for RBCs (from 1.9 to 1.2 units/patient; p = 0.0004), for plasma (from 1.8 to 1.2 units/patient; p = 0.0038), and for PLTs (from 0.7 to 0.4 units/patient; p < 0.0001), but not for cryoprecipitate (from 0.24 to 0.18 units/patient; p = 0.13). Whole hospital (from admit to discharge) utilization decreased significantly for plasma and PLTs, but the changes for RBCs and cryoprecipitate were nonsignificant. CONCLUSION Despite challenges in abstracting data from the electronic medical record, using such data to create provider-specific audits with feedback can be an effective tool to promote quality improvement. Future plans include audits with feedback for providers who order transfusion outside the operating room.
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variability in Blood and Blood Component utilization as assessed by an anesthesia information management system
Anesthesiology, 2012Co-Authors: Steven M Frank, William J Savage, Jim A Rothschild, Richard J Rivers, Paul M Ness, Sharon Paul, John A UlatowskiAbstract:BACKGROUND Data can be collected for various purposes with anesthesia information management systems. The authors describe methods for using data acquired from an anesthesia information management system to assess intraoperative utilization of Blood and Blood Components. METHODS Over an 18-month period, data were collected on 48,086 surgical patients at a tertiary care academic medical center. All data were acquired with an automated anesthesia recordkeeping system. Detailed reports were generated for Blood and Blood Component utilization according to surgical service and surgical procedure, and for individual surgeons and anesthesiologists. Transfusion hemoglobin trigger and target concentrations were compared among surgical services and procedures, and between individual medical providers. RESULTS For all patients given erythrocytes, the mean transfusion hemoglobin trigger was 8.4 ± 1.5, and the target was 10.2 ± 1.5 g/dl. Variation was significant among surgical services (trigger range: 7.5 ± 1.2-9.5 ± 1.1, P = 0.0001; target range: 9.1 ± 1.2-11.3 ± 1.4 g/dl, P = 0.002), surgeons (trigger range: 7.2 ± 0.7-9.8 ± 1.0, P = 0.001; target range: 8.8 ± 0.9-11.8 ± 1.3 g/dl, P = 0.001), and anesthesiologists (trigger range: 7.2 ± 0.8-9.6 ± 1.2, P = 0.001; target range: 9.0 ± 0.9-11.7 ± 1.3 g/dl, P = 0.0004). The use of erythrocyte salvage, fresh frozen plasma, and platelets varied threefold to fourfold among individual surgeons compared with their peers performing the same surgical procedure. CONCLUSIONS The use of data acquired from an anesthesia information management system allowed a detailed analysis of Blood Component utilization, which revealed significant variation among surgical services and surgical procedures, and among individual anesthesiologists and surgeons compared with their peers. Incorporating these methods of data acquisition and analysis into a Blood management program could reduce unnecessary transfusions, an outcome that may increase patient safety and reduce costs.
Nadia B Hensley - One of the best experts on this subject based on the ideXlab platform.
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balancing the Blood Component transfusion ratio for high and ultra high dose cell salvage cases
Journal of Cardiothoracic and Vascular Anesthesia, 2021Co-Authors: Kevin R Merkel, Eric A. Gehrie, Steven M Frank, Nadia B Hensley, Sophia Lin, Tymoteusz J Kajstura, Nicolas C Cruz, James H Black, Brian C ChoAbstract:Objective To assess the ratio of non-red Blood cell to red Blood cell Components required to avoid coagulopathy when transfusing large amounts of salvaged Blood using laboratory test–guided therapy. Design Retrospective cohort study. Setting Single-center, academic hospital. Participants Thoracoabdominal and abdominal open aortic surgery patients. Measurement and Main Results Thirty-eight patients in whom at least 1,000 mL of salvaged red Blood cells were transfused were identified and divided into the following 2 cohorts: 1,000-to-2,000 mL of salvaged red Blood cells (high dose) (n = 20) and >2,000 mL of salvaged red Blood cells (ultra-high dose) (n = 18). Compared with the high-dose cohort, the ultra high-dose cohort received ∼4 times more salvaged red Blood cells (1,240 ± 279 mL v 5,550 ± 3,801 mL). With transfusion therapy guided by intraoperative coagulation tests and thromboelastography, the adjusted ratio of non-red Blood cell to red Blood cell Components (plasma + platelets + cryoprecipitate:allogeneic + salvaged red Blood cells) was 0.59 ± 0.66 in the high-dose and 0.93 ± 0.27 in the ultra high-dose cohorts. Multiple coagulation parameters were normal and similar between cohorts at the end of surgery, as determined by the mean, median, and 95% confidence intervals. Conclusions When transfusing large volumes of salvaged Blood, it is important to balance the ratio between non-red Blood cell and red Blood cell Components. Through a laboratory test–guided approach, coagulopathy was not detected when transfusing Blood in ratios of approximately 1:2 for patients receiving 1,000-to-2,000 mL of salvaged Blood and 1:1 for patients receiving >2,000 mL of salvaged Blood.
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how do i audit intraoperative Blood Component utilization in cardiac surgery
Transfusion, 2019Co-Authors: Nadia B Hensley, Steven M Frank, Brian C Cho, Mereze Visagie, Laeben Lester, James H AbernathyAbstract:BACKGROUND Patient Blood management programs are tasked with auditing transfusions for appropriateness; however, cardiac surgical programs have high variability in Blood utilization. After benchmarking intraoperative Blood utilization as higher than expected, we devised effective methods for audits with feedback to the cardiac anesthesiologists that are described in this report. STUDY DESIGN AND METHODS Red Blood cell (RBC), plasma, platelet (PLT), and cryoprecipitate transfusion data were collected from the electronic record system for 2242 patients having cardiac surgery from July 2016 until July 2018. In July 2017, we performed audits with feedback using rank-order bar graphs displayed on the anesthesiology office door for intraoperative Blood utilization. Individual providers were compared to their peers for all four major Blood Components, with the goal of improving practice by reducing variability. RESULTS After the audits with feedback, the intraoperative mean units/patient decreased for RBCs (from 1.9 to 1.2 units/patient; p = 0.0004), for plasma (from 1.8 to 1.2 units/patient; p = 0.0038), and for PLTs (from 0.7 to 0.4 units/patient; p < 0.0001), but not for cryoprecipitate (from 0.24 to 0.18 units/patient; p = 0.13). Whole hospital (from admit to discharge) utilization decreased significantly for plasma and PLTs, but the changes for RBCs and cryoprecipitate were nonsignificant. CONCLUSION Despite challenges in abstracting data from the electronic medical record, using such data to create provider-specific audits with feedback can be an effective tool to promote quality improvement. Future plans include audits with feedback for providers who order transfusion outside the operating room.
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wrong patient Blood transfusion error leveraging technology to overcome human error in intraoperative Blood Component administration
The Joint Commission Journal on Quality and Patient Safety, 2019Co-Authors: Nadia B Hensley, Colleen G Koch, Peter J Pronovost, Bommy Hong Mershon, Joan Boyd, Susan Franklin, Dana Moore, Kristen Sheridan, Anne Steele, Tracey L StiererAbstract:Background Confirmation of match between patient and Blood product remains a manual process in most operating rooms (ORs), and documentation of dual-signature verification remains paper based in most medical institutions. A sentinel event at Johns Hopkins Hospital in which a seriously ill patient undergoing an emergent surgical procedure was transfused with a unit of incompatible red Blood cells that had been intended for another patient in an adjacent OR led the hospital to conduct a quality improvement project to improve the safety of intraoperative Blood Component transfusions. Methods A multidisciplinary quality improvement project team led a four-phase implementation of bedside bar code transfusion verification (BBTV) for intraoperative Blood product administration. Manual random sample audits of Blood Component transfusions were used to examine accuracy of documentation from July 2014 through June 2016. After the transition to the Epic anesthesia information management system (AIMS) in July 2016, automated Epic reports were generated to provide population-level audits. Results After initiation of BBTV and the addition of Epic AIMS, compliance with obtaining three metrics on documentation of patient identification (two electronic signatures, start and stop times of transfusion, and Blood volume transfused) was improved during a one-year period to > 96%. Pre-Epic audits had shown a mean compliance of only 86%, mainly reflecting a lack of paper Blood Component requisitions. Conclusion By implementing BBTV and using a novel intraoperative documentation process within the Epic AIMS, a safer process of Blood transfusion in the ORs was initiated and documentation improved.
Melissa M Cushing - One of the best experts on this subject based on the ideXlab platform.
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Blood Component utilization in covid 19 patients in new york city transfusions do not follow the curve
Transfusion, 2021Co-Authors: Robert A Desimone, Victoria Costa, Kathleen Kane, Jorge L Sepulveda, Grant B Ellsworth, Roy M Gulick, Jason Zucker, Magdalena E Sobieszcyk, Joseph E Schwartz, Melissa M CushingAbstract:Background Blood suppliers and transfusion services have worked diligently to maintain an adequate Blood supply during the COVID-19 pandemic. Our experience has shown that some COVID-19 inpatients require transfusion support; understanding this need is critical to Blood product inventory management. Study design and methods Hospital-wide and COVID-19 specific inpatient Blood product utilization data were collected retrospectively for our network's two tertiary academic medical centers over a 9-week period (March 1, 2020-May 2, 2020), when most inpatients had COVID-19. Utilization data were merged with a COVID-19 patient database to investigate clinical demographic characteristics of transfused COVID-19 inpatients relative to non-transfused ones. Results Overall, 11 041 COVID-19 patients were admitted and 364 received Blood product transfusions for an overall transfusion rate of 3.3%. COVID-19 patients received 1746 Blood Components in total, the majority of which were red Blood cells. COVID-19 patients' weekly transfusion rate increased as the pandemic progressed, possibly reflecting their increased severity of illness. Transfusion was significantly associated with several indicators of severe disease, including mortality, intubation, thrombosis, longer hospital admission, lower hemoglobin and platelet nadirs, and longer prothrombin and activated partial thromboplastin times. As the pandemic progressed, institutional adherence to transfusion guidelines improved for RBC transfusions compared to prior year trends but did not improve for platelets or plasma. Conclusion There is a need to closely monitor the Blood product inventory and demand throughout the COVID-19 pandemic as patients' transfusion needs may increase over time. Daily or weekly trending of patients' clinical status and laboratory values may assist Blood banks in inventory management.
Rolf Rossaint - One of the best experts on this subject based on the ideXlab platform.
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coagulopathy and Blood Component transfusion in trauma
BJA: British Journal of Anaesthesia, 2005Co-Authors: Donat R Spahn, Rolf RossaintAbstract:Trauma is a serious global health problem, accounting for approximately one in 10 deaths worldwide. Uncontrollable bleeding accounts for 39% of trauma-related deaths and is the leading cause of potentially preventable death in patients with major trauma. While bleeding from vascular injury can usually be repaired surgically, coagulopathy-related bleeding is often more difficult to manage and may also mask the site of vascular injury. The causes of coagulopathy in patients with severe trauma are multifactorial, including consumption and dilution of platelets and coagulation factors, as well as dysfunction of platelets and the coagulation system. The interplay between hypothermia, acidosis and progressive coagulopathy, referred to as the 'lethal triad', often results in exsanguination. Current management of coagulopathy-related bleeding is based on Blood Component replacement therapy. However, there is a limit on the level of haemostasis that can be restored by replacement therapy. In addition, there is evidence that transfusion of red Blood cells immediately after injury increases the incidence of post-injury infection and multiple organ failure. Strategies to prevent significant coagulopathy and to control critical bleeding effectively in the presence of coagulopathy may decrease the requirement for Blood transfusion, thereby improving clinical outcome of patients with major trauma.