Surgical patients requiring massive blood transfusion therapy present many challenges for the anesthetist. The decision to transfuse homologous banked blood and its components must be weighed against the potential complications that may occur in this form of therapy. A review of metabolic changes that occur in banked blood, the risk of infection, and physiologic derangements that may develop during massive blood transfusion are presented.
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Herein, we report the cases of two patients with hemolysis, elevated liver enzymes, and low platelets syndrome who underwent emergent Cesarean sections that were complicated by massive hemorrhage due to undiagnosed hepatic rupture. Intraoperative General Surgery team intervention, early activation of massive transfusion protocol, hemostatic resuscitation, and transfer to ICU resulted in the survival of both patients.
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