In this episode, episode 31, I welcome one of our amazing chief residents to the show, Dr. Stephen Freiberg. Stephen has taken an interest in massive transfusion and he goes over the highlights of when to do it, how to do it, what complications you see from it and how to manage those complications.
4 thoughts on “Episode 31: Massive Transfusion with Dr. Stephen Freiberg”
Great episode. One question: you mentioned trending lactate as a marker for overall patient status. I have heard that some trauma programs use base deficit as a surrogate marker. What are the advantages/disadvantages to using lactate vs. base deficit as markers of appropriate resuscitation and general patient condition?
Also, regarding the use of O+ blood for male patients and not giving RhoGam; on another podcast (I believe it was emcrit) a speaker mentioned that there is a fair amount of “trauma recidivism” in young men and that a second trauma requiring transfusion could put them at risk if they had received O+ in the past and that this subset of patients (although probably hard to predict) should be offered/given Rhogam if they receive Rh positive products. Just thought it was interesting.
Thanks for the podcast.
Hi Alex, thanks for the comment. I think for most purposes you can use base deficit trends to get a feel for where your perfusion is going. Base deficit will reflect lactate, as well as other acids. In the setting of sepsis or other cause of poor perfusion you should see the lactate and the base deficit get worse, or get better, together.
My understanding is that if someone receives O+ blood for trauma resuscitation it would be unrealistic to give RhoGam to try to counteract it. The quantity of RhoGam required would be enormous. But I’ll look into whether this is a phenomenon and I’ll let you know if I find anything else out.
Great episode, as always. I just wanted to clarify one thing. The ABC (assessment of blood consumption) score has been based on a score of 2 or more, not just greater than 2 as stated in this episode multiple times.
You are correct, thanks for pointing that out!