Search
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.