protocol

Definition

> 10 units of packed red blood cells per 24 hours

Goal of massive transfusion protocol

Limit critical hypoperfusion while surgical hemostasis obtained

Limit complications

Issues

1.  Volume status and oxygenation

Volume via crystalloids required to maintain tissue perfusion

At some stage blood is also required for oxygenation

2.  Acidosis

Definition

Technetium 99m labelled MDP (Mono - diphosphonate)

Advantages

1.  Pure gamma emitter

2.  Half life only 6 hours

- limits radiation exposure

3.  Localises in bone

- chemical interaction on the surface of the hydroxyapatite crystal of bone

- phosphorous component interacts with the endogenous calcium

- produces insoluble technetium calcium phosphate complexes.