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Recent developments in the area of massive transfusion

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Abstract

In 2 previous reviews of the subject of massive transfusion, this author noted that one of the most distressing complications of massive transfusion, pathological diffuse bleeding, was poorly understood, but was almost certainly not something induced by the transfusions themselves. Much better evidence is now available relating to the development of coagulopathies during transfusion, and these studies will be reviewed here. In both the prior reviews, the author also noted that one of the potentially most important aspects of massive transfusion was the effect on immunologic defenses, but that this was almost entirely ignored. This situation has now changed dramatically, and most of this review will deal with the rapidly emerging data on this aspect of transfusion. Most of the other aspects of massive transfusion have not changed substantially since the previous reviews.

Résumé

Dans 2 précédentes revues consacrées à la transfusion massive, publiées en 74 et en 76, l'auteur avait noté que la saignement diffus anormal qui pouvait lui succéder, complication gravissime, restait inexpliqué mais que ce phénomène pathologique n'était pas provoqué par la transfusion massive elle-même. Aujourd'hui le développement de coagulopathies chez l'homme soumis à transfusion massive est mieux compris grâce à des études qui sont rapportées dans ce nouvel article. Dans les deux anciennes revues l'auteur avait également noté que l'un des aspects potentiels les plus importants de la transfusion massive était son éventuel retentissement sur les défenses immunologiques, fait qui était alors pratiquement ignoré. Cette situation a totalement changé et la majeure partie de ce nouveau travail est consacré aux données récentes concernant ce dernier phénomène, données qui se développent rapidement alors que les autres faits concernant la transfusion sanguine n'ont pratiquement pas varié.

Resumen

En 2 revisiones previas sobre el tema de la transfusíon masiva, este autor anotó como una de las mas nocivas complicaciones de la transfusión masiva, la hemorragia patológica difusa, era pobremente comprendida, pero ciertamente no significaba un fenómeno inducido por las transfusiones mismas. Ya existe mejor evidencia relativa al desarrollo de coagulopatías en el curso de transfusiones; los estudios pertinentes son revisados en el presente artículo. En las 2 revisiones anteriores, el autor también observó como uno de los aspectos potencialmente más importantes de la transfusión masiva era el efecto sobre las defensas inmunes, pero que eśte permanecía casi totalmente olvidado. Esta situatión ha cambiado dramáticamente el la actualidad, y la mayor parte de la presente revisión se refiere a la información que rapidamente se acrecenta sobre este aspecto de la transfusión. La mayor parte de los otros aspectos de la transfusión masiva no han tenido un cambio significativo desde las 2 revisiones previas.

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Correspondence to John A. Collins M.D..

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Collins, J.A. Recent developments in the area of massive transfusion. World J. Surg. 11, 75–81 (1987). https://doi.org/10.1007/BF01658464

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Keywords

  • Public Health
  • Como
  • Good Evidence
  • Previous Review
  • Massive Transfusion