In the case of a massive transfusion, what is a critical complication to monitor for?

In the context of massive transfusion, coagulopathy is a critical complication to monitor for due to multiple factors related to the transfusion process itself. Massive transfusion refers to the replacement of a large volume of blood (typically defined as more than 10 units of packed red blood cells in a 24-hour period). This situation often arises in trauma cases, surgical emergencies, or other conditions requiring rapid restoration of blood volume.

When large quantities of stored blood are transfused, there is a risk of dilutional coagulopathy. This occurs because the fresh frozen plasma, platelets, and clotting factors present in the whole blood or in smaller units of red cell concentrate are often not replaced proportionately with the red blood cells. As more red cells are given, the patient’s levels of clotting factors and platelets can drop, leading to a bleeding diathesis.

Furthermore, stored red blood cells can also undergo changes during storage, particularly in terms of their viability and function. There are issues such as reduced platelet functionality, decreased levels of anticoagulant factors, and the accumulation of storage-related byproducts that can impair hemostasis. Therefore, it's essential to monitor for signs of coagulopathy, such as increased bleeding tendency or abnormal laboratory