From the Research
Massive Transfusion Protocol (MTP) is a standardized emergency procedure used to rapidly deliver large volumes of blood products to patients experiencing severe hemorrhage, typically involving a balanced ratio of packed red blood cells, fresh frozen plasma, and platelets (often 1:1:1) to replace lost blood volume while maintaining appropriate coagulation factors, as supported by the most recent study 1.
Key Components of MTP
- Administration of packed red blood cells, fresh frozen plasma, and platelets in a balanced ratio to replace lost blood volume and maintain coagulation factors
- Activation when a patient is anticipated to require transfusion of more than 10 units of blood within 24 hours or 4 units within an hour
- Primarily used in trauma settings, major surgeries, obstetric emergencies, and gastrointestinal bleeding where significant blood loss threatens life
Benefits of MTP
- Prevents coagulopathy, acidosis, and hypothermia—the "lethal triad" that can develop during massive hemorrhage
- Reduces delays in blood product delivery and streamlines the resuscitation process
- Improves survival rates in critically bleeding patients, as shown in a study where a high ratio of plasma and platelets to packed red blood cells in the first 6 hours of massive transfusion improved outcomes 2
Additional Considerations
- Calcium supplementation to counter citrate toxicity from stored blood
- Tranexamic acid to reduce fibrinolysis
- Point-of-care testing to guide ongoing transfusion needs
- The use of a 1:1:1 ratio for the resuscitation of patients with severe injury, shock, and uncontrolled hemorrhage is supported by the bulk of currently available data, including the Pragmatic Randomized Optimal Plasma and Platelet Ratios (PROPPR) trial 1