Massive transfusion: red blood cell to plasma and platelet unit ratios for resuscitation of massive hemorrhage

  title={Massive transfusion: red blood cell to plasma and platelet unit ratios for resuscitation of massive hemorrhage},
  author={Colin Murphy and John R Hess},
  journal={Current Opinion in Hematology},
Purpose of reviewThe aim of this short study is to review recently published data bearing on how to resuscitate massive uncontrolled hemorrhage. Recent findingsNew data inform our understanding of the mechanisms of the acute coagulopathy of trauma, the median time to death of trauma patients with uncontrolled hemorrhage, the effects of blood product composition on the coagulation capacity of infused resuscitation mixtures, the outcomes of patients resuscitated according to common massive… 

Transfusion in patients with massive blood loss: evidence when, for whom and what products are best

For trauma patients in particular, a subsequent and timely switch from dilution with intravenous fluids, to evidence-based ratios of fresh frozen plasma, platelet concentrates and packet red blood cells is critical.

Efficacy of Resuscitative Transfusion With Hemoglobin Vesicles in the Treatment of Massive Hemorrhage in Rabbits With Thrombocytopenic Coagulopathy and Its Effect on Hemostasis by Platelet Transfusion

HbV transfusion effectively rescued rabbits from severe hemorrhage with coagulopathy, without disturbing hemostasis after the platelet transfusion, and may be practical and useful in prehospital resuscitation.

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Hemorrhage is responsible for 30 to 40% of all trauma-related mortality. Among adult trauma patients, 94% of hemorrhage-related deaths occur within 24 h and approximately 60% of these deaths within 3

Platelet Transfusion for Trauma Resuscitation

Future focus on a deeper understanding of the biology of platelets following trauma, and on optimization of novel platelet-based therapeutics to maintain hemostatic effects while improving availability should be pursued.

Transfusion Practice in Trauma Resuscitation

Hemostatic resuscitation using defined blood component ratios modified by early laboratory results can lead to more efficient blood product usage and improved patient outcomes.

Proactive Use of Plasma and Platelets in Massive Transfusion in Trauma: The Long Road to Acceptance and a Lesson in Evidence-Based Medicine.

A transfusion ratio for plasma:platelet:PRBC of 1:1:1 cannot be recommended as the standard of care for massive transfusion during trauma resuscitation in Canada because of the lack of randomized controlled trials (RCTs) validating it.

1: 1 Transfusion strategies are right for the wrong reasons

Hemorrhagic profiles suggest a rapid onset of clot formation in all subgroups but significantly suppressed thrombin burst and diminished clot strength in the most injured patients, suggesting goal-directed resuscitation may be more effective in resuscitating the most coagulopathic patients.

Platelet Transfusion in Critical Care and Surgery: Evidence-Based Review of Contemporary Practice and Future Directions

This review explores evidence and recommendations for platelet transfusion thresholds and practices in a variety of critical care and surgical settings with specific focus on the role of platelets transfusion in trauma, management and reversal of anticoagulation, and point of care laboratory assays.

Management of Critical Bleeding in Trauma Patients: Between Recommendations and Reality

Recognizing the predictors of mortality with early monitoring of prothrombin time, activated partial thromboplastin time, fibrinogen and platelets, target haemostatic therapy with lysine derivates and substituted coagulation factors in order to avoid packed red blood cells and fresh frozen plasma, are of vital importance.

The impact of blood product ratio and procoagulant therapy on the development of thromboembolic events in severely injured hemorrhaging trauma patients

A systematic review identified an incidence of thromboembolic events of 10% in severely injured bleeding trauma patients and found the use of TXA and fibrinogen concentrate was associated with the development of thROMboembolics complications.



Resuscitate early with plasma and platelets or balance blood products gradually: Findings from the PROMMTT study

Plasma transfusion early in resuscitation had a protective association with mortality, whereas delayed but gradually balanced transfusion ratios did not; further research will require considerably larger numbers of patients receiving platelets early.

Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial.

Among patients with severe trauma and major bleeding, early administration of plasma, platelets, and red blood cells in a 1:1:1 ratio compared with a 1-1:2 ratio did not result in significant differences in mortality at 24 hours or at 30 days, but more patients in the 1:2:2 group achieved hemostasis and fewer experienced death due to exsanguination by 24 hours.

Early resuscitation intensity as a surrogate for bleeding severity and early mortality in the PROMMTT study

Resuscitation with four or more units of any fluid was significantly associated with 6-hour mortality and this study suggests that early RI regardless of fluid type can be used as a surrogate for sickness and mortality in severely bleeding patients.

Prehospital Transfusion of Plasma and Red Blood Cells in Trauma Patients

  • J. HolcombDaryn P. Donathan C. Wade
  • Medicine
    Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
  • 2015
Improved early outcomes are associated with placing blood products prehospital, allowing earlier infusion of life-saving products to critically injured patients, as well as negligible blood products wastage, but not an overall survival advantage.

The Natural History and Effect of Resuscitation Ratio on Coagulation After Trauma: A Prospective Cohort Study

Resuscitation with a “low ratio” of RBC:FFP leads to earlier correction of coagulopathy, and earlier and prolonged repletion of some but not all procoagulant factors.

Making thawed universal donor plasma available rapidly for massively bleeding trauma patients: experience from the Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial

The Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial was a randomized clinical trial comparing survival after transfusion of two different blood component ratios for emergency

Transfusion and coagulation management in major obstetric hemorrhage

A massive transfusion protocol provides a key resource in the management of severe P PH, however, future studies are needed to assess whether formula-driven vs. goal-directed transfusion therapy improves maternal outcomes in women with severe PPH.

Pretrauma center red blood cell transfusion is associated with reduced mortality and coagulopathy in severely injured patients with blunt trauma.

PTC RBC administration was associated with a lower risk of 24-hour mortality, 30-day mortality, and TIC in severely injured patients with blunt trauma, warranting further prospective study.

Redefining massive transfusion when every second counts

The traditional definition of MT is inadequate to reflect illness severity and clinical trials involving transfusion strategies should consider CAT as an instrument for evaluating outcomes.