Transfusion therapy in the care of trauma and burn patients

The oldest reports of successful blood transfusions for trauma come from the American Civil War. Motor-vehicle-related injuries, interpersonal violence, and falls are the most common causes of fatal injuries. Traditionally, there are four phases of trauma care: prehospital, emergency department, operative care, and postoperative intensive care. Mass casualty trauma situations are uncommon, and those requiring large amounts of blood are rare. The resuscitation of patients with severe burns is different than that of patients with penetrating and/or blunt force trauma. Tranexamic acid and epsilon-amino caproic acid are lysine analogs used as antifibrinolytics. Plasma-derived coagulation factors potentially allow rapid restoration of coagulation system activity in severely injured patients. The glycoprotein fibrinogen has been shown to mediate platelet and endothelial function and is thought to play a role in the stabilization of syndecan-1 and correction of endotheliopathy.