Massive transfusion can lead to coagulopathy and metabolic complications. MC cause of death after massive transfusion: dilutional coagulopathy or DIC. Transfusion of 15-20 units of blood components causes dilutional thrombocytopenia. After massive blood transfusion initially transient hyperglycemia due to glucose in preservatives leading to insulin release and causing hypoglycemia (MC) Galvimetric method of estimation of blood loss: Blood loss during operation is measured by weighing the swabs after use & substracting the dry weight plus volume of blood collected in suction or drainage. Metabolic complications of Massive Transfusion: General Electrolyte Fluid overload Hypothermia Impaired oxygen delivery capacity of Hb (decreased 2,3-DPG) Hyperkalemia Hypocalcemia Hypomagnesemia Metabolic acidosis(rare) Metabolic alkalosis Transfusion Protocols BT should commence within 30 minutes or removing blood bag from refrigerators because of increased risk of bacterial contamination. Whole blood or packed RBC transfusion must be completed within 4 hours. Platelet and FFP transfusion should be completed within 20 minutes. Transfusion set should have standard filter of 170microm size. Usual transfusion needle size should be of 18-19 gauge. Ref: Harrisons 19th edition Pgno: 138