New frontiers in critical bleeding

  • S. Busani
  • L. Donno
  • M. Girardis


The exact definition of critical haemorrhage remains a matter of debate, but the majority view is that it can be defined as bleeding requiring emergency intervention to avoid the patient’s death or tissue/organ loss (e.g. liver, uterus) [1]–[3]. The first step in critical haemorrhage is the control of bleeding source by means of surgery, radiological or endoscopic intervention and medical therapy in patients with inherited or acquired coagulopathies. Unfortunately, these strategies are sometimes not available or do not allow definitive control of bleeding, particularly in the case of severe trauma patients. In fact, massive bleeding remains one of the main causes of death in trauma patients, and it is usually caused by a combination of vascular injury and coagulopathy [4]. In these patients, together with diffuse injuries, secondary coagulopathy is a key factor in failed bleeding control. The causes of this coagulopathy are multifactorial, and both hypothermia and acidosis can worsen haemostasis function further [4]–[5]. Cosgriff et al. [6] indicate that trauma patients transfused with more than 10 units of packed red blood cells and the combination of injury severity score >25, pH<7.10, temperature <34°C and systolic blood pressure <70mmHg have a 98% chance of developing a severe coagulopathy (PT and aPTT twice the normal values). Among these different risk factors, hypothermia and acidosis have been identified as the two main ones involved in the development of coagulopathy [6].


Trauma Patient Injury Severity Score Severe Coagulopathy Injure Trauma Patient Severe Trauma Patient 
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Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • S. Busani
    • 1
  • L. Donno
    • 1
  • M. Girardis
    • 1
  1. 1.Anaesthesia and Intensive Care Unit IModena University Hospital and Modena and Reggio Emilia UniversityItaly

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