Blood transfusion (dilutional thrombocytopenia)

Stored blood is subject to considerable loss of functional platelets and labile coagulation factors - e.g. Factors II, V and VII - but not fibrinogen or Factors II, VII, IX, X and XI.

Large volume transfusion of such blood may result in:

• dilutional thrombocytopenia
• disseminated intravascular coagulopathy - often attributed to the underlying or associated conditions
• impaired platelet function

Laboratory investigations reveal:

• increased PT, APTT, bleeding time
• reduced plasma levels of fibrinogen, Factors V and VIII
• thrombocytopenia

Management:

• review patient's clinical condition; underlying disease; presence of anatomical bleeding lesions; results of coagulation tests
• consider fresh frozen plasma - which contains the plasma proteins and labile clotting factors
• consider cryoprecipitate - rich in Factor VIII and fibrinogen - especially if DIC is evident as fibrinogen is required in addition to clotting factors