Massive transfusion causes the following except:
a. Massive transfusion implies a single transfusion greater than 2500 mL or 5000 mL transfused over a period of 24 hours. A variety of problems can attend the use of massive transfusion.
b. Circulatory overload or DIC might occur.
c. Dilutional thrombocytopenia, impaired platelet function, and deficiencies of factors V, VIII, and XI result.
d. Routine alkalization is not advisable because this could have an adverse effect on the hemoglobin dissociation curve and also is accompanied by an increased sodium load.
e. Citrate toxicity from the use of stored blood may result in young children, in patients with severe hypotension, or in patients with liver disease. The toxicity is related to an excessive binding of ionized calcium. The use of stored blood also provides a potassium load, but there are no effects in the face of normal renal function.
h. If diffuse bleeding is noted, coagulation tests and platelet counts should be measured and deficiencies corrected.