Blood reviews
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Injury is the leading cause of death in young people and a major cause of loss of years of productive life world wide. Acute surgical care can prevent injury from turning into disability or death but requires prompt access to safe blood products to support resuscitation and restorative surgical procedures. ⋯ Safety and diagnostic support are critical in the post-resuscitative period where transfusion complications can delay reconstructive surgery and prolong intensive care unit stays. This paper reviews the epidemiology of injury and modern patterns of trauma care against the background of developing knowledge about the coagulopathies of trauma and blood safety.
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As activation of the coagulation pathway is a physiological response to injury, the development of disseminated intravascular coagulation (DIC) is a warning signal to the clinician that the primary pathological disease state is decompensating. In pregnancy, DIC can occur in several settings, which include emergencies such as placental abruption and amniotic fluid embolism as well as complications such as pre-eclampsia. Whilst the acuteness of the event and the proportionality in the coagulant and fibrinolytic responses may vary between these different conditions, a common theme for pregnancy-associated DIC is the pivotal role played by the placenta. ⋯ This is necessary because DIC itself can have pathological consequences that translate clinically into a worse prognosis for affected patients. This article will describe how pregnancy-associated DIC can be diagnosed promptly and how treatment should be managed strategically. It also discusses the latest developments in our understanding of haemostatic mechanisms within the placenta and how these may have relevance to new diagnostic approaches as well as novel therapeutic modalities.