UMEM Educational Pearls

Title: Massive Transfusion Protocols

Category: Critical Care

Keywords: massive transfusion, bleeding (PubMed Search)

Posted: 9/23/2014 by Feras Khan, MD (Updated: 11/22/2024)
Click here to contact Feras Khan, MD

What is a massive transfusion?

Can be institution dependent but usually means greater than 10 Units of blood products transfused within 24hrs.
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.

When would I use this?

Indications:

-Systolic Blood pressure < 100

-Unable to obtain blood pressure

AND

-Penetrating torso trauma

-Positive FAST

-External blood loss

-Plans to go to the OR

How do I give it?

The transfusion ratio is usually 1:1:1 or 2:1:1
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.

Does this apply for just traumatic bleeding?

Although this data was based on soldiers in the recent Iraq Wars, it has been used for medical patients as well.
Therefore, consider using in upper GI bleeds, post-partum hemorrhage, etc.

Are there other agents I can use?

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.

What am I trying to do with this protocol?

Murthi SB, Stansbury LG, Dutton RP, et al. TRAnsfusion medicine in trauma patients: an update. Expert Rev Hematol. 2011 Oct;4(5):527-37.

Hess JR, et al. The coagulopathy of trauma: a review of mechanisms. J Trauma. 2008 Oct; 65(4):748-54.

University of Maryland SHOCK Trauma Massive Transfusion Protocol. 2011.