Question

Case Introduction A 35-year-old male patient presents to the emergency room after being involved in a hunting-related shooting accident. The emergency room physician caring for the patient needs to order blood products from the blood bank but is unsure of exactly what or how much the patient will need. He calls a more experienced trauma physician and asks what the best protocol will be. The patient is bleeding profusely. The emergency room physician is told to enact the massive transfusion protocol to stabilize the patient.

1. What is the best initial step in the process to enact the Massive Transfusion Protocol?  

2. While the lab is performing the type and crossmatch, the patient is transfused with packed RBCs at a steady pace. The lab is quickly running out of O Negative units. What other type of products should you normally transfuse during a massive trauma according to a standard massive transfusion protocol?

3. What type of laboratory tests are used to monitor patients undergoing massive transfusion?

Answer 1

1. The best initial step in the process to enact Massive Transfusion Protocols(MTP) is to confirm that the patient meets criteria for activation. Then order for MTP and call the blood bank.

Criteria- replacement of >1 blood volume in 24hr or >50% of blood volume in 4 hr.

2. Consider FFP, Platelets, Tranexanic acid (in trauma patients) and also cryoprecipitate (if fibrinogen <2g/L) along with O negative PRBC.

3. Full blood coun, coagulation screen (PT, INR, APTT, fibrinogen), biochemistry and ABG.