Massive blood loss
Expected or unexpected major haemorrhage.
Seek advice from haematologist if:
Non-surgical uncontrolled bleeding despite PRBCs/FFP/platelets
Warfarin overdose
Newer oral anticoagulants (e.g. dabigatran/rivaroxaban)
Inherited bleeding disorder (e.g. haemophilia, von Willebrand disease)
Maintain Hb > 80 g.l⁻¹
Maintain platelet count > 75×10⁹ l⁻¹
Maintain PT and APTT <1.5 × mean control (FFP)
Maintain fibrinogen >1.0 g.l⁻¹ (cryoprecipitate)
Avoid DIC (maintain blood pressure, treat/prevent acidosis, avoid hypothermia, treat hypocalcaemia and hyperkalaemia)
CALCIUM (use either the chloride or gluconate):
Adult: 10 ml of 10% calcium chloride i.v.
Adult: 20 ml of 10% calcium gluconate i.v.
Child: 0.2 ml.kg⁻¹ of 10% calcium chloride i.v.
Child: 0.5 ml.kg⁻¹ of 10% calcium gluconate i.v.
TRANEXAMIC ACID:
Child: 15 mg.kg⁻¹ i.v. bolus then 2 mg.kg⁻¹.h⁻¹ until bleeding stops
Adult: 1 g i.v. bolus, then:
Obstetric haemorrhage, repeat dose 30 min later
Non-obstetric haemorrhage, 1 g i.v. infusion over next 8 h