Massive Transfusion Protocol
Activate when anticipate ...
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Description

Massive Transfusion Protocol

Activate when anticipate transfusing 50% TBV (~5U pRBC) in 2h OR 100% TBV (~10U pRBC or 5L plasma) in 24h

Complications: dilutional coagulopathy, hypothermia, hypocalcemia (citrate), metabolic alkalosis (citrate metabolized to bicarb)

Emergency release un-crossmatched pRBCs (O- for pre-menopausal females, O+ ok for males and older females)

Transfuse 1U FFP for every 3-4 pRBCs (if >6 U pRBCs anticipated), 6-pk PLT (PLT<100,000 anticipated), 10U cryo (fibrinogen <100)

 • No evidence for 1:1:1 transfusion protocol, combat trauma studies confounded by survival bias (JAMA 2015;313:471)

 • Excessive FFP a/w higher ARDS in pts not requiring massive transfusion

 • Goals: Hb >7-10, PLT >50,000, INR <2, fibrinogen >100

Correct coagulopathy (A/C, liver dz) → IV vit K, FFP 15cc/kg; platelet dysfunction (ASA, plavix, uremia) → PLTs, DDAVP 0.3 mcg/kg

Consider IV aminocaproic acid @ 5g bolus over 1h, then 1g/hr gtt x 8h or IV TXA @ 1g bolus over 10min, then 1g over 8h



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Account created for the MGH Internal Medicine Housestaff Manual "White Book" - https://stk10.github.io/MGH-Docs/WhiteBook-2019-2020.pdf
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