Massive Hemorrhage (Generalized Oozing) in Patients Undergoing Major Surgery; Effect of Multiple Transfusions; Changes in Clotting Factors Responsible

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AbstractOver 100 patients undergoing extensive surgery have been studied with careful evaluation of excessive bleeding during and after surgery. Clotting factors including prothrombin, Factor V, Factor VII, platelet counts, fibrinogen, fibrinolytic activity, whole clot lysis and citrate levels have been measured before operation and at frequent intervals during operation. Twenty of the followed patients oozed excessively during surgery.In none of these was the bleeding fatal. However, in five patients first studied in the recovery room, with excessive bleeding the mortality was 80%. Prompt treatment based on the laboratory findings and recognition of the condition explains the difference in results.Fibrinolytic activity was the most frequently observed abnormality. Of those in whom a sample of the blood was obtained just before or at the beginning of oozing, all but one showed fibrinolysis.Other patients who did not ooze also showed fibrinolysis. The signification difference (statistically) was that in the oozers one or more of the other clotting factors also became abnormal, most commonly fibrinogen or Factor V, in all but one patient. The most marked changes in the clotting factors occurred in patients undergoing hepatic resections.The plasma citrate concentrations bore no relationship to the occurrence of oozing.

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