Thrombocytopaenia (dilutional)
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
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