UMEM Educational Pearls

Category: Critical Care

Title: Massive Transfusion Protocols

Keywords: massive transfusion, bleeding (PubMed Search)

Posted: 9/23/2014 by Feras Khan, MD (Updated: 3/29/2024)
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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?

  • Control hemorrhage
  • Use the best products possible
  • Prevent hypothermia
  • Prevent hemodilution
  • Treat coagulopathy

References

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.