Draft:Massive transfusion protocol

• Comment: probably notable but medical articles require better sources than this and please note we don't use external links in the body of an article. Theroadislong (talk) 15:30, 19 October 2024 (UTC)

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A massive transfusion protocol (MTP) is a medical guideline used to manage patients experiencing severe hemorrhage. It is typically activated in cases of polytrauma, obstetric emergencies (e.g., postpartum hemorrhage), or major surgeries that result in life-threatening blood loss. MTPs aim to prevent mortality and morbidity associated with massive hemorrhage by addressing complications such as acidosis, hypothermia, and coagulopathy, often referred to as the "lethal triad."

Definition

There are several definitions of "massive transfusion" in the medical literature. These include:

• Replacement of one entire blood volume within 24 hours.
• Transfusion of more than 10 units of packed red blood cells (PRBCs) within 24 hours.
• Transfusion of more than 4 units of PRBCs in one hour with ongoing need expected.
• Replacement of 50% of total blood volume within three hours.

These criteria indicate the scale of blood loss that necessitates rapid and coordinated transfusion efforts.

Indications for activation

MTPs are typically activated in clinical situations where ongoing severe blood loss threatens a patient’s hemodynamic stability. Common indications include:

• Ongoing bleeding with a heart rate over 110 beats per minute or a systolic blood pressure (SBP) less than 90 mmHg.
• Major thoracic, abdominal, pelvic, or long-bone trauma.
• Significant obstetric, gastrointestinal, or surgical hemorrhage.
• Anticipated transfusion of four or more units of red cell concentrates within four hours, coupled with hemodynamic instability or continued bleeding.

Rationale

MTPs are activated in response to the complications that arise from massive hemorrhage, specifically acidosis, hypothermia, and coagulopathy. These protocols ensure the timely and balanced replacement of red blood cells (RBCs), fresh frozen plasma (FFP), and platelets. Standard ratios often employed include 1:1:1 or 2:1:1 (RBCs:FFP), although these may vary based on institutional practices. The goal is to improve patient outcomes by restoring blood volume, correcting clotting factor deficiencies, and stabilizing the patient’s condition.

Challenges and limitations

Massive transfusion protocols have certain limitations. One of the primary challenges is the lack of standardization regarding the appropriate ratio of blood components and the exact trigger for initiating the protocol. The activation criteria may vary between hospitals and trauma centers. In some cases, premature activation can lead to unnecessary transfusions and wastage of blood products, putting a strain on blood bank resources.

References

Patil V, Shetmahajan M. Massive transfusion and massive transfusion protocol. Indian J Anaesth. 2014 Sep;58(5):590-5. doi: 10.4103/0019-5049.144662. PMID: 25535421; PMCID: PMC4260305.