When faced with significant bleeding in a patient, initiating a Massive Transfusion Protocol (MTP) with the Blood Bank is crucial. While the specific ratio of blood products used in MTP may vary by institution, the underlying principle remains consistent. The protocol typically involves administering several units of Packed Red Blood Cells (PRBC) and Fresh Frozen Plasma (FFP) in each cycle, along with periodic administration of platelets (where Platelet Apheresis is equivalent to 8-10 standard units of platelets) and/or cryoprecipitate. An initial supplementation of fibrinogen in the range of 3-4 grams is also recommended.
Monitoring coagulation is essential during MTP and includes tests such as prothrombin time (PT), activated partial thromboplastin time (APTT), platelet counts, fibrinogen levels, and/or viscoelastic coagulation tests like Thromboelastography (TEG). The target for hemoglobin levels should be maintained at 7-9 g/dl. Plasma, either FFP or pathogen-inactivated plasma, should be administered as necessary to keep PT and APTT below 1.5 times the normal control values. Platelets should be provided to sustain a platelet count above 50 × 10^9/L. Additionally, the use of tranexamic acid may be considered to help minimize bleeding during the process.
