Accession Number:

ADA629442

Title:

The Impact of Platelet Transfusion in Massively Transfused Trauma Patients

Descriptive Note:

Journal article

Corporate Author:

ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX

Report Date:

2010-11-01

Pagination or Media Count:

8.0

Abstract:

BACKGROUND The impact of platelet transfusion in trauma patients undergoing a massive transfusion MT was evaluated. STUDY DESIGN The Institutional Trauma Registry and Blood Bank Database at a Level I trauma center was used to identify all patients requiring an MT greater than or equal to 10 packed red blood cells PRBC within 24 hours of admission. Mortality was evaluated according to 4 apheresis platelet aPLTPRBC ratios Low ratio less than 118, medium ratio greater than or equal to 118 and less than 112, high ratio greater than or equal to 112 and less than 16, and highest ratio greater than or equal to 16. RESULTS Of 32,289 trauma patients, a total of 657 2.0 required an MT. At 24 hours, 171 patients 26.0 received a low ratio, 77 11.7 a medium ratio, 249 37.9 a high ratio, and 160 24.4 the highest ratio of aPLTPRBC. After correcting for differences between groups, the mortality at 24 hours increased in a stepwise fashion with decreasing aPLTPRBC ratio. Using the highest ratio group as a reference, the adjusted relative risk of death was 1.67 adjusted p 0.054 for the high ratio group,2.28adjusted p 0.013for the medium ratio group ,and 5.51 adjusted p less than 0.001 for the low ratio group. A similar stepwise increase in mortality with decreasing platelet ratio was observed at 12 hours after admission and for overall survival to discharge. After stepwise logistic regression, a high aPLTPRBC ratio adjusted p less than 0.001 was independently associated with improved survival at 24 hours. CONCLUSIONS For injured patients requiring a massive transfusion, as the apheresis platelet-to-red cell ratio increased, a stepwise improvement in survival was seen. Prospective evaluation of the role of platelet transfusion in massively transfused patients is warrand.

Subject Categories:

  • Anatomy and Physiology
  • Medicine and Medical Research

Distribution Statement:

APPROVED FOR PUBLIC RELEASE