MASSIVE TRANSFUSION

PROTOCOL
BANGALORE BAPTIST HOSPITAL
Definition of massive haemorrhage

• Total blood volume is replaced within 24hrs.

• 50% of total blood volume is replaced within 3hrs
• Rapid bleeding rate is documented or observed ie,>4 RBCS are
transfused within 4hrs of active major bleeding or more than
150ml/min of blood loss.
 Incomplete
control of
massive
bleeding

Sys.coagulopath
y,Haemodilution
MOF endothelial
damage

ACIDOSIS HYPOTHERMIA
M
Protocol driven transfusion strategies advice a 1:1:1 (packed red
blood cell(PRBC),FFP and platelet) ratio in patients requiring
transfusion

Shown to improve patient survival,reduce hospital/ICU stay and

reduce patient care costs.
 66%

34%
1 19%
1:2.5
:
8
1:1.4
Ratio of blood products transfused affects mortality
in patients receiving massive transfusions.
Mimics whole blood proportions
Whole blood out whole blood in
Any attempt to increase the concentration of one
component would lead to dilution of the other two.
 Bedside component administration

LARGE BORE PRESSURE INFUSION

BLOOD WARMER
NEEDLES BAGS
 Haemoynamically
•Identify cause. unstable:
•Initial Actual or anticipated 4 units
Uncontrolled
measures: RBCS<4hrs;haemodynamically unstable +/- bleed
• Compression ongoing bleeding Systolic
• Tourniquet •Severe thoracic,abdominal,pelvic or BP<90mmHg
• Packing multiple long bone trauma;FAST + HR>120/min
• Surgical • Major obstetric,gastrointestinal or surgical Ph<7.24
assessment- bleeding Haemoglobin< 8
early surgery or
angiography

Clinician determines that patient meets

the criteria for MTP

2 large bore IV’s or central venous access Full blood count, coagulation
profile(PT,INR,APTT),grouping and cross
matching,ABG,ionized calcium, fibrinogen
Avoid hypothermia and maintain normothermia (warm
blankets,blood and fluid warmers);Avoid excessive
crystalloid(to prevent dilutional coagulopathy)
Arterial line,urinary catheterization ,hemodynamic
Monitoring (permissive hypotension 90mmhg)

ACTIVATE CODE
MASSIVE
TRANSFUSION
PROTOCOL AREA
 Blood bank sends O negative blood and 2pints
Of unthawed AB Plasma immediately
Every 30-60 min monitor:
Blood bank staff collects required forms, and Cross
CBC,coagulation
match
profile
samples from bedside
Ionized calcium
ABG
Saline crossmatch is done in
15minnne
5s5 PRBCS FFPS+6 platelets is issued by blood bank to Target:
staff
Temp>35 degree
celsius

Ph>7.2

Transfusion initiated per protocol in 1:1:1 ratio Base excess<-6

Further blood pints will Lactate<4mmol/l
Blood Bank provides new MTP
pack to patient bedside with a targeted Calcium>1.1 mmol/l
frequency every 30 minutes until MTP is
terminated by MTP Leader Platelets>50x1000
Give tranexamic acid 1 gm 0 0/l
over 10 min and start
PT/APTT<1.5 X
transfusion if indicated
normal
Give 3 g CaCl at completion of
INR<1.5
each MTP pack
Fibrinogen>1.0g/l
Repeat labs as needed
 Target Endpoints Achieved?

Has the bleeding stopped/Controlled

Yes No

Cease Continue

MTP MTP

Reassess patient
for adequate
haemorrhage
control and for
endpoints
Review-debriefing after every
MTP CODE by the involved
team
Feedback
Mock drills
RIGHT BLOOD COMPONENT

RIGHT PATIENT

RIGHT AMOUNT

RIGHT TIME
References

• International journal of clinical transfusion medicine 2016:4 15-

27:Massive transfusion protocols:current best practices
• Massive transfusion for coagulopathy and and haemorrhagic
shock:surgical critical care evidence based medicine guideline
committee; Approved 05/25/2010,Revised 08/012012;11/2/2017
THANK YOU