Massive blood transfusion is associated with a wide range of adverse effects, some of which are understood, but controversy surrounds the effects of massive blood loss and transfusion on haemostasis and oxygen transport. Until we have a better understanding of the underlying pathophysiology and while storage of blood remains imperfect, there is a good case for the empirical use of super-fresh blood in this clinical setting. A practical approach to the exsanguinated patient is presented.
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