TYK341

A 7 year-old female patient comes to the operating room for debridement and skin grafting of 65% TBSA burns. During the procedure, bleeding is significant and she requires her estimated blood volume to be replaced twice with packed red blood cells and FFP. On admission to the pediatric intensive care unit, ongoing oozing is noted, and her dressings are quickly saturated. Which of the following is the most likely cause of her bleeding?

a) Factor VII deficiency

b) DIC

c) Thrombocytopenia

d) Factor XIII deficiency

e) Medication error

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Answer

Answer c. Packed red blood cells are nearly devoid of platelets and coagulation factors. Administration of large volumes of packed red blood cells, especially in the case of replacement of entire blood volumes, is associated with dilutional coagulation defects. The most likely cause of the ongoing oozing is thrombocytopenia, as this usually presents first after massive transfusion. However, a full coagulation panel should always be checked. DIC is also a possibility in patients with severe injury, thus evaluation for fibrin degradation products would be appropriate as well.

Notes

This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.

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