3a Emergency and massive transfusion

Emergency and massive transfusion represents a particular challenge for clinician and transfusion medicine specialist. The impressive improvements of blood component preparation and quality over the last 10 years have rendered most of the specific risks of massive transfusion negligible. Today specific risks caused by massive transfusion are only to be expected in case of very fast transfusion (replacement of one blood volume in 3–4 hours) and/or large volume replacement (two blood volumes in 24 hours). Furthermore, the individual situation of the patient is the main decisive factor in the outcome. On the other hand, emergency transfusion includes several particular risks which can only be sufficiently managed by appropriate organizational measures and defined replacement schemes. These are different in situations related to complications of elective surgery or to emergency admission. This article describes how to manage emergency transfusion under these different circumstances in order that the highest safety and rapid blood supply can be achieved.