Complications of massive transfusion

Chest. 2010 Jan;137(1):209-20. doi: 10.1378/chest.09-0252.


Massive transfusion (MT) is a lifesaving treatment of hemorrhagic shock, but can be associated with significant complications. The lethal triad of acidosis, hypothermia, and coagulopathy associated with MT is associated with a high mortality rate. Other complications include hypothermia, acid/base derangements, electrolyte abnormalities (hypocalcemia, hypomagnesemia, hypokalemia, hyperkalemia), citrate toxicity, and transfusion-associated acute lung injury. Blood transfusion in trauma, surgery, and critical care has been identified as an independent predictor of multiple organ failure, systemic inflammatory response syndrome, increased infection, and increased mortality in multiple studies. Once definitive control of hemorrhage has been established, a restrictive approach to blood transfusion should be implemented to minimize further complications.

Publication types

  • Review

MeSH terms

  • Blood Coagulation Disorders / blood
  • Blood Coagulation Disorders / etiology*
  • Blood Coagulation*
  • Blood Transfusion / mortality
  • Humans
  • Multiple Organ Failure / blood
  • Multiple Organ Failure / etiology*
  • Prognosis
  • Risk Factors
  • Shock, Hemorrhagic / therapy*
  • Survival Rate
  • Systemic Inflammatory Response Syndrome / blood
  • Systemic Inflammatory Response Syndrome / etiology*
  • Thrombocytopenia / blood
  • Thrombocytopenia / etiology*
  • Transfusion Reaction*