Diagnosis: Massive transfusion factor VII
• Increasing evidence supports the use of a high ratio of red blood cells: platelets: plasma in massively transfused patients.
• The use of high ratios of red blood cells: platelets: plasma has been associated with improved survival.
• Different definitions of massive transfusion have been used, but the two most common are transfusion of 10 U or more of RBCs or replacement of a patient’s blood volume in 24 hours or less.
• The patient in this question has received too many platelet doses and not enough plasma based upon current evidence.
• Recombinant activated factor VII complexes with tissue factor to activate factor X to factor Xa and factor IX to factor IXa.
• The activation of these factors leads to activation of the common pathway of coagulation and formation of a fibrin plug.
• For this to occur, sufficient quantities of substrate must be present.
• This patient needs additional plasma and cryoprecipitate to help ensure efficacy of recombinant activated factor VII.
