Blood and blood products
Packed red blood cell (PRBC) and fresh frozen plasma (FFP)
In order to maintain tissue oxygen delivery and restore an
effective coagulation, early administration of PRBCs and fresh
frozen plasma is recommended (Grade 1B). The administration
of red blood cells is considered indispensable when the
Hb levels are less than 7 g%.
The administration of fresh frozen plasma should be as
early as possible with transfusion of PRBCs in order to
compensate for the deficit in coagulation factors and also to
prevent dilutional coagulopathy. FFP transfusion is recommended
when APTT and INR are1.5 times the normal. The
most frequently recommended initial dose is 10e15 ml/kg
and further doses should be based on coagulation
parameters.
Though several recent studies have highlighted the
importance of high PRBC:FFP ratio (ratio of approximately
1:1), these studies have a potential for survival bias (patients
who have died early are more likely to have received
a higher PRBC:FFP ratio). Thus the optimal value of
PRBC:FFP ratio remains controversial. Because FFP requires
a significant amount of time before it is thawed and available
for transfusion and many trauma deaths occur soon
after hospital admission, patients who die early may
receive RBC units but die before FFP therapy has begun. The
PRBC:FFP ratio is an important element in early PRBC and
FFP transfusion, but the time at which the FFP transfusion
has begun would determine the outcome in terms of mortality
rather than the ratio of PRBC to FFP.23,24 The role of
whole blood is limited to the military setting where walking
blood banks are created. In civilian practice whole blood
has no role due to the concern of transmission of viral
infections.
Platelet transfusion
Platelets should be transfused to maintain a blood platelet
count of more than 50,000/cumm in trauma patients and more
than 100,000/cumm in patients with traumatic brain injury