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Massive transfusion complications occur when a patient receives a large volume of blood products within a short period, typically during severe trauma, major surgery, or life-threatening haemorrhage. Although massive transfusion can be lifesaving, it may lead to several serious complications if not carefully managed. Rapid replacement of blood can disrupt the body's normal balance of clotting factors, platelets, electrolytes, and body temperature.

One of the most significant complications is dilutional coagulopathy, where clotting factors and platelets become diluted, increasing the risk of continued bleeding. Hypocalcaemia may develop due to citrate in stored blood binding calcium, while hyperkalaemia can occur from potassium released by stored red blood cells. Hypothermia is another common concern because refrigerated blood products lower body temperature, affecting both heart function and blood clotting.

Additional complications include metabolic acidosis, transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), and impaired oxygen delivery if blood storage changes reduce red cell efficiency. Continuous monitoring of vital signs, blood gases, coagulation tests, calcium, potassium, and body temperature is essential throughout treatment.

Modern massive transfusion protocols use balanced ratios of red blood cells, plasma, and platelets to minimise complications. Prompt recognition, multidisciplinary teamwork, and targeted supportive care improve survival, reduce organ damage, and enhance recovery in critically ill patients.