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Ann Card Anaesth. 2018 Oct-Dec;21(4):433-436. doi: 10.4103/aca.ACA_49_18.

The value of institutional protocols and focused cardiac ultrasound during a case of ultramassive transfusion.

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Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA.


A 53-year-old female was admitted to the emergency department with an exsanguinating bleed from the rectum which was of unclear origin. In what could be considered an ultramassive transfusion, 60 units packed red blood cells, 23 units fresh frozen plasma, 20 units platelets, 6 units cryoprecipitate, 30 L of crystalloids, 2 L of colloids, and 4 g of tranexamic acid were transfused over the course of 7 h. An arterio-enteric fistula was diagnosed and treated by an interventional radiologist. The patient recovered rapidly thereafter without any major neurologic, pulmonary, cardiac, or hematologic complications.


Blood components; focused cardiac ultrasound; massive transfusion

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