Title: Massive Transfusion Pearls

Category: Critical Care

Posted: 4/17/2013 by Mike Winters, MBA, MD

Massive Transfusion Pearls

As discussed in previous pearls, massive transfusion (MT) is defined as the transfusion of at least 10 U of packed red blood cells (PRBCs) within 24 hours.
While the optimal ratio of PRBCs, FFP, and platelets is not known, most use a 1:1:1 ratio.
Though scoring systems have been published to identify patients who may benefit from MT (ABC, TASH, McLaughlin), they have not been shown to be superior to clinical judgment.
A few pearls when implementing massive transfusion for the patient with traumatic shock:
- Monitor temperature and aggressively treat hypothermia.
- Monitor fibrinogen levels and replace with cryoprecipitate if needed.
- Monitor calcium and potassium. MT can induce hypocalcemia and hyperkalemia.

Elmer J, et al. Massive transfusion in traumatic shock. J Emerg Med 2013; 44:829-838.