Massive transfusion protocols for patients with substantial hemorrhage

Transfus Med Rev. 2011 Oct;25(4):293-303. doi: 10.1016/j.tmrv.2011.04.002. Epub 2011 Jun 12.


Transfusion medicine for the resuscitation of patients with massive hemorrhage has recently advanced from reactive, supportive treatment with crystalloid and red blood cell therapy to use of standardized massive transfusion protocols (MTPs). Through MTPs, medical facilities are able to standardize the most effective posthemorrhage treatments and execute them rapidly while reducing potential waste of blood products. Damage control resuscitation is an example of an MTP, where patients are (1) allowed more permissive hypotension, (2) spared large volumes of crystalloid/colloid therapy (through low volume resuscitation), and (3) transfused with blood products preemptively using a balanced ratio of plasma and platelets to red blood cells. This focused approach improves the timely availability of blood components during resuscitation. However, the use of MTPs remains controversial. This review describes published experiences with MTPs and illustrates the potential value of several MTPs currently utilized by academic transfusion services.

Publication types

  • Review

MeSH terms

  • Academic Medical Centers
  • Algorithms
  • Blood Banks / organization & administration
  • Blood Coagulation Disorders / complications
  • Blood Component Transfusion
  • Blood Transfusion / methods*
  • Clinical Protocols
  • Cohort Studies
  • Factor VIII / therapeutic use
  • Fibrinogen / therapeutic use
  • Forecasting
  • Hemorrhage / blood
  • Hemorrhage / etiology
  • Hemorrhage / therapy*
  • Humans
  • Military Medicine
  • Organizational Policy
  • Prescriptions
  • Resuscitation / methods
  • Shock, Hemorrhagic / blood
  • Shock, Hemorrhagic / etiology
  • Shock, Hemorrhagic / therapy
  • Surgery Department, Hospital / organization & administration
  • Trauma Centers
  • Treatment Outcome
  • Wounds and Injuries / complications


  • cryoprecipitate coagulum
  • Factor VIII
  • Fibrinogen