Massive haemorrhage requires massive transfusion (MT) to maintain adequate circulation and haemostasis. For optimal management of massively
bleeding patients, regardless of aetiology (
trauma, obstetrical, surgical), effective preparation and communication between transfusion and other laboratory services and clinical teams are essential. A well-defined
MT protocol is a valuable tool to delineate how blood products are ordered, prepared, and delivered; determine laboratory algorithms to use as transfusion guidelines; and outline duties and facilitate communication between involved personnel. In MT patients, it is crucial to practice damage control
resuscitation and to administer blood products early in the
resuscitation.
Trauma patients are often admitted with early
trauma-induced coagulopathy (ETIC), which is associated with mortality; the aetiology of ETIC is likely multifactorial. Current data support that
trauma patients treated with higher ratios of plasma and platelet to
red blood cell transfusions have improved outcomes, but further clinical investigation is needed. Additionally,
tranexamic acid has been shown to decrease the mortality in
trauma patients requiring MT. Greater use of cryoprecipitate or
fibrinogen concentrate might be beneficial in MT patients from obstetrical causes. The risks and benefits for other
therapies (
prothrombin complex concentrate, recombinant
activated factor VII, or whole blood) are not clearly defined in MT patients. Throughout the
resuscitation, the patient should be closely monitored and both metabolic and coagulation abnormalities corrected. Further studies are needed to clarify the optimal ratios of blood products, treatment based on underlying clinical disorder, use of
alternative therapies, and integration of laboratory testing results in the management of massively
bleeding patients.