Blood Product Transfusions

Blood products carry a risk of initiating or exacerbating respiratory failure.36-39 In a recent study of the DoDTR, moderate numbers of Red Blood Cell (RBC) transfusions (2-14) increased the risk of ARDS. Furthermore, each unit of additional plasma transfused increased the risk of ARDS in intubated combat casualties by 7%.36 Similar findings have also been demonstrated in the civilian trauma population.39 Thus, it is imperative to balance the benefits of Damage Control Resuscitation (DCR) against the risk of ARDS. If the patient is bleeding and needs blood volume replaced, blood products should not be withheld. Furthermore, in patients with severe ARDS refractory to maximal ventilator support, transfusion of additional RBCs may be necessary to sustain adequate oxygen delivery. On the other hand, a patient who is no longer bleeding who has asymptomatic anemia40 or a mildly elevated International Normalized Ratio (INR) with a normal thromboelastogram or rotational thromboelastogram likely does not need additional blood products.