Effects of a hospital-wide introduction of a massive transfusion protocol on blood product ratio and blood product waste

Abstract

Background:Massive transfusion protocols (MTPs) are increasingly used in the transfusion practice and are developed to provide the standardized and early delivery of blood products and procoagulant agents and to supply the transfusion of blood products in a well-balanced ratio.Aim:The aim of this study was to investigate the effect of a hospital-wide introduction of an MTP on blood product ratio and a waste of blood products.Materials and Methods:Retrospective analysis was performed to compare the transfusion practice in massive bleeding patients before and after the introduction of an MTP and between the use of an MTP and transfusion off-protocol. Massive bleeding was defined as an administration of ≥5 units of red blood cells (RBCs) within 12 h.Results:Of 547 massively transfused patients, 192 patients were included in the pre-MTP period and 355 patients in the MTP period. The ratio of RBC to fresh frozen plasma (FFP) and the platelets transfused shifted significantly toward 1:1:1 in the MTP period (P = 0.012). This was mainly caused by a shift in RBC: FFP ratio (P = 0.014). An increase in the waste of blood products was observed, most notably FFPs (P = 0.026). Extending the storage time after thawing reduced the waste of FFPs from 11% to 4%.Conclusion:Hospital-wide introduction of an MTP is an adequate way to achieve a well-balanced transfusion ratio of 1:1:1. This comes at the cost of an increase in the waste of FFPs, which is lowered after extending the duration of storage time after thawing.

Does a balanced transfusion ratio of plasma to packed red blood cells improve outcomes in both trauma and surgical patients? A meta-analysis of randomized controlled trials and observational studies

“…The ideal ratio for balanced transfusion is a controversial issue with multiple facts and considerations ranging from patient outcomes to allocation of resources 1,50 . In their study Borgman and co-authors 11 found a higher transfusion ratio of 1:1.4 was significantly associated with improved mortality when compared to a medium (1:2.5) or low (1:8) ratios (19% vs 34% vs 65%, p<0.001, respectively).…”

Blood component transfusion and wastage rates in the setting of massive transfusion in three regional trauma centers

“…Many centers maintain thawed plasma inventories for use in MTPs to decrease the time required for the provision of plasma . Use of thawed plasma in this setting, however, has been associated with increased waste …”

Quality management of a massive transfusion protocol

“…Planned thawing and issuing of cryoprecipitate was particularly wasteful with 7% to 33% wastage across the sites. Balvers and colleagues report better compliance with recommended ratios of products after the establishment of a MTP. In our transfusion service we record all MTP activations and other large blood use events, achieve balanced product ratios, and have very low levels of wastage averaging less than 1% for all products and excellent compliance on all services.…”