Protocols for massive blood transfusion: when and why, and potential complications.

PURPOSE: An update paper on massive bleeding after major trauma. A review of protocols to address massive bleeding, and its possible complications, including coagulation abnormalities, complications related to blood storage, immunosuppression and infection, lung injury associated with transfusion, and hypothermia is carried out. METHODS: Literature review and discussion with authors' experience. RESULTS: Massive bleeding is an acute life-threatening complication of major trauma, and consequently its prompt diagnosis and treatment is of overwhelming importance. Treatment requires rapid surgical management together with the massive infusion of colloid and blood. CONCLUSIONS: Since massive transfusion provokes further problems in patients who are already severely traumatized and anaemic, once this course of action has been decided upon, a profound knowledge of its potential complications, careful monitoring and proper follow-up are all essential. To diagnose this bleeding, most authors favour, as the main first choice tool, a full-body CT scan (head to pelvis), in non-critical severe trauma cases. In addition, focused abdominal sonography for trauma (FAST, an acronym that highlights the necessity of rapid performance) is a very important diagnostic test for abdominal and thoracic bleeding. Furthermore, urgent surgical intervention should be undertaken for patients with significant free intraabdominal fluid and haemodynamic instability. Although the clinical situation and the blood haemoglobin concentration are the key factors considered in this rapid decision-making context, laboratory markers should not be based on a single haematocrit value, as its sensitivity to significant bleeding may be very low. Serum lactate and base deficit are very sensitive markers for detecting and monitoring the extent of bleeding and shock, in conjunction with repeated combined measurements of prothrombin time, activated partial thromboplastin time, fibrinogen and platelets.

Angiotensin-converting enzyme distribution and hypoxia response in mammal, bird, and fish.

Angiotensin I-converting enzyme activity was measured in homogenates of guinea pig (Cavia porcellus), chicken (Gallus domesticus), and carp (Cyprinus carpio) organs. The highest activity was found in guinea pig lung and chicken kidney. In carp the highest activity was found in heart and spleen, although gill arch also showed a high activity. Acute hypoxia decreased the angiotensin I-converting enzyme activity in guinea pig lung and carp gill arch, but the changes in chicken lung and kidney were considered nonsignificant.

Computed tomography in abdominal Castleman's disease.

Three patients with abdominal Castleman disease studied by CT are presented. Two cases corresponded to localized mesenteric disease and the third to a systemic form of the process. The CT findings are nonspecific, although a dense enhancement of the lesions can be demonstrated sometimes on dynamic CT.