Massive transfusion is defined as the transfusion of 10 or more units of blood within a 24-hour period. The Massive Transfusion Protocol (MTP) is designed to meet the needs of an actively bleeding patient requiring multiple blood components.
1. The MTP leader (trauma surgeon or designate) activates the MTP.
2. When possible, obtain a blood sample before the transfusions begin. This will allow for the proper identification of the patient’s blood type. If it is not possible to obtain the specimen before the transfusions begin, obtain the specimen as soon as possible before many units have been given.
3. The laboratory provides a combination of 4 RBCs and 4 FFPs every 30 minutes and an Apheresis Platelet every hour during the MTP. Refer to the “Emergency Issue, Request for Uncrossmatched Blood” protocol.
A. Immediately following the initiation of an MTP, 4 RBCs will be delivered to the transfusion site in a transport container followed by 4 FFPs upon thawing.
Note: FFP will not be kept thawed in anticipation of activation of an MTP but will be thawed upon activation.
B. The blood banker calls Surgery (or Emergency Room) and asks the MTP leader if the MTP is to continue.
C. If the MTP is to continue 4 RBCs, 4 FFPs and 1 Apheresis platelet will be delivered to the transfusion site in the next 30 minutes.
D. Continue this pattern until the MTP is terminated or modified by the MTP leader. Modifications may include changing the quantities and/or ratios of the components as may be clinically indicated.
4. Universal donor RBC (O Negative) and FFP (AB) will be used until the recipient’s blood type has been established and group and type specific components can be obtained.
A. If supplies are strained, Rh positive blood may be given to Rh negative males or females beyond child-bearing age or who cannot otherwise become pregnant.
B. If Rh positive blood must be given to a Rh negative female of child-bearing age consult a pathologist regarding Rh Immune Globulin treatment.
5. It is not necessary to retest any patient specimen within the 3 day outdate of the original specimen. The original specimen should be used for subsequent crossmatching until the specimen is exhausted.
1. AABB Technical Manual. Current edition.
2. AABB Standards for Blood Banks and Transfusion Services. Current edition.
May 2011 Dr. Edmonds