Mon22November1200AM 16

Are the following true or false with regard to the Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidance on managing haemostatic failure in massive haemorrhage?

True / False

There is no evidence base to recommend tranexamic acid in haemorrhage Correct

Hypocalcaemia is useful in the context of controlling major haemorrhage Correct

Fibrinogen concentrate is licensed for use in the UK Incorrect answer selected

Recombinant factor VIIa (NovoSeven) is associated with a risk of arterial thrombosis and is not recommended in major haemorrhage Incorrect answer selected

Fresh frozen plasma (FFP) can be given empirically to patients with major haemorrhage without reference to a clotting screen Correct

Explanation

In the context of traumatic haemorrhage, administration of red blood cells (RBCs) and fresh frozen plama (FFP) in a ratio of 1:1 should be used to replace fluid volume. Consider the administration of cryoprecipitate (two pools) and platelets (one adult therapeutic dose) until test results are available and bleeding is controlled. Once control is achieved, blood components should be administered as guided by testing at the earliest opportunity.

Fresh frozen plasma (FFP) is recommended in major haemorrhage when fibrinogen is less than 1 g/L or the prothrombin or activated partial prothromplastin time is greater than 1.5 times the laboratory norm. 15-30 ml/kg is the first line dose for FFP.

Fibrinogen concentrate is not licensed in the UK and has to be given on a named patient basis but has the benefit of not needing thawing.

Recent trauma research studies have demonstrated a benefit of tranexamic acid in patients bleeding due to trauma.

Calcium is a key co-factor in activating the coagulation cascade and may be depleted in major trauma (exacerbated by calcium ligands in blood products). To optimise clotting the calcium levels should be monitored and adjusted if needed.

Recombinant factor VIIa is not recommended in major trauma as there is a risk of arterial thrombosis and the manufacturers state that its safety and efficacy has not been established in major trauma.

Reference:

Association of Anaesthetists of Great Britain and Ireland (AAGBI). Blood transfusion and the anaesthetist: management of massive haemorrhage.

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Average score: 75.20%

Times answered: 275