Coagulopathy and blood component transfusion in trauma

Trauma is a serious global health problem, accounting for approximatelyone in 10 deaths worldwide. Uncontrollable bleeding accountsfor 39% of trauma-related deaths and is the leading cause ofpotentially preventable death in patients with major trauma.While bleeding from vascular injury can usually be repairedsurgically, coagulopathy-related bleeding is often more difficultto manage and may also mask the site of vascular injury. Thecauses of coagulopathy in patients with severe trauma are multifactorial,including consumption and dilution of platelets and coagulationfactors, as well as dysfunction of platelets and the coagulationsystem. The interplay between hypothermia, acidosis and progressivecoagulopathy, referred to as the ‘lethal triad’,often results in exsanguination. Current management of coagulopathy-relatedbleeding is based on blood component replacement therapy. However,there is a limit on the level of haemostasis that can be restoredby replacement therapy. In addition, there is evidence thattransfusion of red blood cells immediately after injury increasesthe incidence of post-injury infection and multiple organ failure.Strategies to prevent significant coagulopathy and to controlcritical bleeding effectively in the presence of coagulopathymay decrease the requirement for blood transfusion, therebyimproving clinical outcome of patients with major trauma.