When there is a severe blood shortage it may be impossible to meet the needs of a patient who is massively bleeding. Doughty et al listed conditions where massive transfusion is likely to be futile. The authors are from Barts Health London, University of London, Sunnybrook Health Sciences Centre (Toronto), University of Toronto and Oxford University.
Patient scenario: massively bleeding patient
Patients for whom massive blood transfusion is probably futile:
(1) severe burns (see below)
(2) cardiac arrest AND cause not reversible
(3) advanced and progressive dementia (cognitive impairment)
(4) advanced and progressive neuromuscular disease that is untreatable
(5) metastatic malignancy AND life expectancy less than 6 months
(6) advanced and irreversible immunodeficiency(immunocompromised)
(7) severe and irreversible neurologic event/condition
(8) heart failure NYHA class III or IV
(9) end-stage lung disease (see below)
(10) trauma with significant or non-survivable brain injury
(11) ruptured abdominal aortic aneurysm with cardiac arrest or not eligible for surgery
(12) organ transplant
(13) any other condition with expected mortality > 80%
Severe burn has at least 2 of the following:
(1) age > 60 years
(2) total burn surface area > 60%
(3) inhalation injury AND requires mechanical ventilation
End-stage lung disease:
(1) COPD AND(FEV1 < 25% of predicted OR pulmonary hypertension OR baseline PaO2 < 7 kPa (52.6 mm Hg))
(2) cystic fibrosis AND (post-bronchodilator FEV1 < 30% OR baseline PaO2 < 55 mm Hg)
(3) pulmonary fibrosis AND (VC or TLC < 60% of predicted OR baseline PaO2 < 7 kPa OR pulmonary hypertension)
(4) primary pulmonary hypertension AND (NYHA III or IV OR right atrial pressure > 10 mm Hg OR mean pulmonary arterial pressure > 50 mm Hg)
