Evaluation of the Impact of Apheresis Platelets Used in the Setting of Massively Transfused Trauma Patients.

摘要

Introduction: Trauma is a major cause of morbidity and mortality worldwide. Of patients arriving to trauma centers, patients requiring massive transfusion (MT, greater than 10 units in 24 hours) are a small patient subset but are at the highest risk of mortality. Transfusion of appropriate ratios of blood products to such patients has recently been an area of interest to both the civilian and military medical community. Plasma is increasingly recognized as a critical component, though less is known about appropriate ratios of platelets. Combat casualties managed at the busiest combat hospital in Iraq provided an opportunity to examine this question. Methods: In-patient records for 8,618 trauma casualties treated at the military hospital in Baghdad more than a 3-year interval between January 2004 and December 2006 were retrospectively reviewed and patients requiring MT (n 694) were identified. Patients who required MT in the first 24 hours and did not receive fresh whole blood were divided into study groups defined by source of platelets: (1) patient receiving a low ratio of platelets ( less than 1:16 apheresis platelets per stored red cell unit, aPLT:RBC) (n 214), (2) patients receiving a medium ratio of platelets (1:16 to less than 1:8 aPLT:RBC) (n 154), and (3) patients receiving a high ratio of platelets (greater than or equal to 1:8 aPLT: RBC) (n 96). The primary endpoint was survival at 24 hours and at 30 days. Results: At 24 hours, patients receiving a high ratio of platelets had higher survival (95%) as compared with patients receiving a medium ratio (87%) and patients receiving the lowest ratio of platelets (64%) (log-rank p 0.04 and p less than 0.001, respectively). The survival benefit for the high and medium ratio groups remained at 30 days as compared with those receiving the lowest ratio of platelets (75% and 60% vs. 43%, p less than 0.001 for both comparisons).