• Piotr Paluszkiewicz, Ewa Mayzner-Zawadzka, Włodzimierz Baranowski, Grzegorz H Bręborowicz, Maciej Brzeziński, Grażyna Durek, Adam Dziki, Maria M Czupryńska, Małgorzata Lipińska-Gediga, Magdalena Lętowska, Andrzej Mital, Elżbieta Nowacka, Magdalena Pychyńska-Pokorska, Jerzy Ratajczak, Jan Rogowski, Zbigniew Rybicki, Sławomir Sobieszczyk, Radzisław Trzciński, Marta Wawrzynowicz-Syczewska, Jerzy Windyga, Maria Wujtewicz, and Association for Severe Bleeding Care.
• Association for Severe Bleeding Care Department of Gastrointestinal Surgery, St. John from Dukla Lublin Regional Cancer Centre.
• Pol Przegl Chir. 2011 Aug 1;83(8):465-76.

UnlabelledExsanguination is an underestimated cause of treatment failures in patients with severe trauma or undergoing surgery. In some patients the primary dysfunction of blood clot formation is a direct cause of a massive blood loss. Patients without previous coagulation disorders are at risk of coagulopathy following intraoperative or post-traumatic bleeding, where the local haemostasis does not warrant bleeding cessation.The Aim Of The Studywas to assess the therapeutic value of various components of a complex interdisciplinary approach, based on the opinion of the experts treating patients with massive bleeding.Material And MethodsThe study was conducted by anonymous questionnaire, using the analogue representation of the argument strength. The results were analyzed based on the techniques of descriptive statistics. The argument was considered a key parameter, when the median value of strength was located in the highest quartile.ResultsIt was found that the arguments of the highest strength for the risk of developing the posthaemorrhagic coagulation disorders are: loss of more than one third of blood volume, fluid therapy in an amount greater than 35 ml/kg, administration of more than 5 units of packed red blood cells, insufficient supply of fresh frozen plasma and platelets in proportion to packed red blood cells, severe acidosis and hypothermia. The most important tests for post-haemorrhage coagulopathy are: anatomically non-localized bleed, abnormal values of the standard coagulation parameters and fibrinogen level below 1 g/L. In the treatment of post-haemorrhagic coagulopathy the team of experts pointed out the benefits of antifibrinolytic drugs, concentrates of prothrombin complex and recombinant activated coagulation factor VII.ConclusionsMultidisciplinary therapeutic management of bleeding patients is associated with employment of appropriate treatment methods to achieve the best possible outcome. Factors influencing the development of coagulopathy, the methods of diagnosis and proposed techniques of treatment may facilitate therapeutic decisions in bleeding patients requiring massive transfusion of blood components.

26 keywords...

hide…