Sýcak taze tam kan masif kanamalý acil durumlarda ilk seçenek olmalý mýdýr?

Hýzlý masif kanamanýn erken yönetimi, kan ürünlerinin erken verilmesi ve hýzlý cerrahi kontrolün saðlanmasýný gerektirir. Periferik hastaneler kaynak kýsýtlýlýðý nedeniyle askeri koþullara benzer. Kan ürünleri bulunmayan periferik bir hastanede masif kanamayla nedeniyle sýcak taze tam kan (TTK) verdiðimiz üç olgu sunuldu. Olgu1: On altý yaþýnda kadýn hasta acil sezaryana alýndý. Uterus atonisi nedeniyle masif kanamasý olan hastanýn Hb deðeri 3.5g/dl’ye kadar düþtü. Cerrahi süresince altý ünite sýcak TTK transfüzyonu yapýldýktan sonra, hemodinamik parametreleri ve tam kan sayýmý normal düzeye geldi. Ýki gün yoðun bakýmda takibi yapýlan hasta, yedinci gün taburcu edildi. Olgu 2: Otuz beþ yaþýnda kadýn hasta acil sezaryana alýndý. Uterus atonisi nedeniyle masif kanayan hastanýn Hb’i 2g/dl, Htc’i %5.4’e kadar düþtü. Dokuz ünite sýcak taze tam kan verilen hastanýn hemodinamik ve laboratuvar deðerleri normal düzeye geldi. Ertesi gün ekstübe edilip üçüncü gün yoðun bakýmdan servise çýkarýlan hasta sekizinci günde taburcu edildi. Olgu 3: Otuz altý yaþýnda erkek hasta býçak yaralanmasý sonrasý hemorajik þokta acil cerrahiye alýndý. Hastada sað renal arter ve böbrek yaralanmasý vardý. Cerrahi süresince kanamaya devam eden hastaya dokuz ünite sýcak TTK verildi. Cerrahi kontrol saðlanan ve kan transfüzyonu yapýlan hastanýn hemodinamik parametreleri düzeldi. Beþinci gününde yoðun bakýmdan çýkarýlan hasta 10. günde taburcu edildi. Kan bileþenlerine ayrýlabildiðinden beri sivil týpta TTK kullanýmý neredeyse yoktur. Ayrýca, kan bankalarýnda tam kan rutin mevcut deðildir. Bu nedenle tam kan kullanýmý sivil týpta azalmýþtýr. Sýcak TTK masif transfüzyonda, kýrmýzý kan hücrelerini, trombositleri, plazma volümünü, koagülasyon faktörlerini etkili bir þekilde yerine koyarken ayný zamanda hipotermiyi ve dilüsyonel koagülopatiyi önler. Kan ürünleri, uzun depolanma süresince biyokimyasal, biyomekanik ve immünolojik deðiþikliklere uðrar. Depolama süresi transfüzyon etkinliðini ve transfüzyonla iliþkili riskleri etkiler. Gelecekte hýzlý ABO uyumluluðu testleri, trombosit koruyucu lökosit filtreleri ve patojenleri azaltan yeni teknolojilerin kullanýmý ile TTK massif transfüzyonda ilk seçim olabilir. Yeni çalýþmalar gelecekte yeni prosedürler ortaya çýkaracaktýr.

Should warm fresh whole blood be the first choice in acute massive hemorrhage in emergency conditions?

Early management of rapid massive hemorrhage requires early administration of blood products and rapid surgical control of bleeding. Professionals in peripheral hospitals with limited resources often work under conditions similar to those in the military. Described in the present report are 3 cases in which warm fresh whole blood (WFWB) was used in patients with massive bleeding who presented to a peripheral hospital that had no blood products suitable for emergency conditions. Described first is the case of a 16-year-old female patient who underwent emergency cesarean section. The patient had massive bleeding from the uterus due to atony. Her hemoglobin (Hb) dropped to 3.5 g/dL. Six units of WFWB were transfused during surgery. Hemodynamic parameters and complete blood count (CBC) stabilized. She was transferred from the intensive care unit (ICU) to obstetrics on day 2 and was discharged on day 7. Described second is the case of a 35-year-old female patient who also underwent emergency cesarean section, and for whom massive bleeding was due to uterine atony. Hb dropped to 2 g/dL and hematocrit (HCT) to 5.4%. Nine units of WFWB were transfused, after which hemodynamic and laboratory parameters stabilized. The patient was extubated the following day, transferred from the ICU to obstetrics on day 3, and was discharged on day 8. Described third is the case of a 36-year-old male patient with stab injuries and hemorrhagic shock who underwent emergency surgery. The patient had injuries to the right renal artery and kidney. Nine units of WFWB were transfused due to continued hemorrhage during surgery. Following surgical control of bleeding and transfusion, hemodynamic parameters improved. The patient was transferred from the ICU on day 5 and discharged on day 10. WFWB transfusion nearly disappeared from civilian medicine after blood was separated into components, and whole blood is not usually available at blood banks. In massive transfusions, WFWB effectively replaces red blood cells (RBCs), platelets, plasma volume, and coagulation factors, while preventing hypothermia and dilutional coagulopathy. Blood components go through biochemical, biomechanical, and immunological changes during long storage, the duration of which affects both transfusion efficacy and associated risks. In the future, with the use of fast donor tests, fast ABO compatibility tests, platelet-sparing leukocyte filters, and developments in pathogen-decreasing technology, fresh whole blood (FWB) may be the first choice for massive transfusion. Future studies will reveal new procedures.