Editing Mass Transfusion Protocol


There are two main definitions used:

* '''Austin guideline:''' the transfusion of 50% blood volume in 4 hours, or >1 blood volume in 24 hours (blood volume is approx. 70mL/kg).
** Which is going to be approx. 8 units per 4 hours, or 16 units per 24 hours
** Activate the protocol when you anticipate >4 units required, or when 4 have been transfused in 4 hours and more is required.
* '''ATLS''' defines adult MTP as 4 units in one hour or 10 units in 24 hours

== '''Goals''' ==

* Maintain tissue perfusion and oxygenation
* Prevent trauma-induced or resuscitation-induced coagulopathy
* Aggressive control of bleeding

== '''Pathophysiology of coagulopathy in trauma''' ==

* Acute trauma - endogenous process whereby injury and hypoperfusion lead to acidosis, impairing coagulation cascade
* Resuscitation - unbalanced resus dilutes/does not replace clotting factors
* 'Trauma-induced coagulopathy' has been defined as acute traumatic and resuscitation-induced coagulopathy combined

== Epidemiology ==

* In trauma, risk is high in these patients:
** SBP <70
** HR >110 and SBP <90
** Penetrating injury or major fractures
** Fluid in body cavities likely to be blood

== '''Process:''' ==

* Contact blood bank on 4630 (at Austin)
* Designate one person as liaison who will provide basic information to lab
* Pre-transfusion sample collected and sent
* pRBC and platelets take about 5 minutes, while FFP/cryo takes 30 mins
* Ratio 
** The common phrase is '1:1:1' but really what they mean is 4 units RBC, 4 units FFP and 1 bag of pooled platelets (which is somehow equivalent to 4 units)
*** 2024 update to Austin guidelines states 8 units pRBC : 1 bag pooled platelets = 4 units platelets : 4 bags FFP
** Give first bag FFP after 4 units of RBC have gone in
**
* FBE and coags every 30 mins
* Consider tranexamic acid (1g IV over 10 mins followed by 1g over 8 hours) - best evidence if given within 3 hours; worth giving up to 8 hours
* Recombinant factor VIIa can be considered as last resort in ongoing bleeding

== '''Complications:''' ==

* Hypocalcaemia
** Citrate is present in blood products, which chelates calcium
** Can lead to coagulopathy
** Calcium will need to be replaced
* Hyperkalaemia
* Acidosis
* Standard transfusion complications

== Blood products ==

* Packed red blood cells
** Red cell component after centrifuging to remove platelets and most plasma
** Additives '''SAG-M''': saline, adenine, glucose, mannitol
** Volume 260mL
** Storage temp 2-6 degrees
** Shelf life 42 days
* Platelets
** Platelets obtained from a group of ABO-identical donors, with leucocytes removed
** Additives: citrate, phosphate, acetate, potassium, magnesium
** Volume 367mL, which is equivalent to about 20-40 change in serum platelets
** Storage temp 20-24 degrees
** Shelf life 5 days
* Fresh frozen plasma
** Made up of plasma collected via apheresis or separated from whole blood
** Contains all coagulation factors
** No additives
** Volume about 270mL
** Storage temp <-25deg
** Shelf life 12 months frozen, then 2-6 degrees for 5 days
* Cryoprecipitate
** Contains factors VIII and XIII, fibrinogen, fibronectin
** No additives
** Volume 36mL
** Dose 1 unit per 5-10kg, to increase Fib by 0.5-1.0g/L
** Storage temp <-25 degrees
** Shelf life 12 months frozen
* Request times
** pRBC, platelets and generic FFP take 5-10 minutes to prepare
** Group-specific FFP and cryoprecipitate take 30 minutes to thaw

[[Category:Trauma]]
[[Category:Haematology]]