A 45-year-old man is admitted to the ICU after a motor vehicle collision and is found to have a continuing transfusion requirement. Injuries include a grade III laceration of the spleen, multiple rib fractures, and bilateral femoral fractures. In the operating room he receives 15 units of packed red blood cells, and 10 units of fresh frozen plasma.
Which of the following is most likely to cause coagulopathy as a result of the transfusion of blood products in this patient?
A. Decreased serum fibrinogen concentration
B. Decreased serum ionized calcium concentration
C. Dilutional thrombocytopenia
D. Disseminated intravascular coagulation
答案解析：
大量输血后出血可由低体温、稀释性凝血病、血小板功能障碍、纤维蛋白溶解或低纤维蛋白原血症引起。输注大量血液制品(> 10-15 U)如浓缩红细胞(PRBC)和新鲜冷冻血浆(FFP)最有可能产生稀释性血小板减少，这可导致获得性凝血病。在这种情况下，输注15个单位的PRCS + 10个单位的FFP将引起显著的稀释性血小板减少。为了防止这种现象，美国外科医师学会认可的大量输血方案建议每6个单位的PRBC给予1次单采献血者的血小板或随机献血者的血小板池。
正确答案：C
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