Title: Massive Transfusion Protocols<br/>Author: Feras Khan<br/><a href='http://umem.org/profiles/faculty/1145/'>[Click to email author]</a><hr/><p>
<strong>What is a massive transfusion?</strong></p>
<ul>
<li>
Can be institution dependent but usually means greater than 10 Units of blood products transfused within 24hrs.</li>
<li>
Most hospitals have this as a protocol that a physician can order to notify the blood bank that a large volume of blood products may be required rapidly.</li>
</ul>
<p>
<strong>When would I use this?</strong></p>
<p>
<em>Indications:</em></p>
<p>
-Systolic Blood pressure < 100</p>
<p>
-Unable to obtain blood pressure</p>
<p>
<span style="background-color: #ffff00">AND</span></p>
<p>
-Penetrating torso trauma</p>
<p>
-Positive FAST</p>
<p>
-External blood loss</p>
<p>
-Plans to go to the OR</p>
<p>
<strong>How do I give it?</strong></p>
<ul>
<li>
The transfusion ratio is usually 1:1:1 or 2:1:1</li>
<li>
Give 1 unit PRBC, then 1 U FFP, and alternate until 6 units of each have been given and then 1 bag of apheresis platelets (6 equivalent units). Can repeat as needed.</li>
</ul>
<p>
<strong>Does this apply for just traumatic bleeding?</strong></p>
<ul>
<li>
Although this data was based on soldiers in the recent Iraq Wars, it has been used for medical patients as well.</li>
<li>
Therefore, consider using in upper GI bleeds, post-partum hemorrhage, etc.</li>
</ul>
<p>
<strong>Are there other agents I can use?</strong></p>
<ul>
<li>
There is some data to give tranexamic acid early (less than three hours from injury) in trauma patients who are hypotensive and are having severe bleeding.</li>
</ul>
<p>
<strong>What am I trying to do with this protocol?</strong></p>
<ul>
<li>
Control hemorrhage</li>
<li>
Use the best products possible</li>
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Prevent hypothermia</li>
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Prevent hemodilution</li>
<li>
Treat coagulopathy</li>
</ul>
<fieldset><legend>References</legend>
<p>
Murthi SB, Stansbury LG, Dutton RP, et al. TRAnsfusion medicine in trauma patients: an update. Expert Rev Hematol. 2011 Oct;4(5):527-37.</p>
<p>
Hess JR, et al. The coagulopathy of trauma: a review of mechanisms. J Trauma. 2008 Oct; 65(4):748-54.</p>
<p>
University of Maryland SHOCK Trauma Massive Transfusion Protocol. 2011.</p>
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