See also: [[Acute transfusion reactions]], [[FFP]], [[TEG, ROTEM, coagulation studies|ROTEM]], [[cryoprecipitate]], [[Prothrombinex]], [[Warfarin, DOAC, heparin reversal|Reverse anticoagulation]]
[[Blood transfusion (paeds)]], [[Blood transfusion]]
- [Dunns Blood products](x-devonthink-item://7D54D5DB-6474-4DA5-9C8C-78F2E7FDA33D)
- [REBEL EM trauma updates 2023](https://rebelem.com/trauma-resuscitation-updates/) ; [Cubox link of this]([Trauma Resuscitation Updates - REBEL EM - Emergency Medicine Blog](cubox://card?id=7161289766422446218))
- [Predict massive transfusion in trauma 2017](bookends://sonnysoftware.com/ref/DL/257901)
- traditional definition was ≥ 10 units/24 hours
- 5 units in 4 hours
- ≥ 10 units in 6 hours also used
> **note:** pRBCs in Australia do not contain much citrate anymore. [[Hypocalcemia]] can still occur in trauma from blood loss and the "lethal diamond" factors.
# MTP Targets
- temp > 35 deg C
- Acid/base - ph >7.2, BE >-6, lactate <4
- ionised calcium >1.1
- plt >50
- PT/APTT <1.5 of normal
- INR <1.5
- fibrinogen >1.5 (>2.5 in pregnancy-related MTP)
# 1:1:1
finding of the [PROPPR trial](https://www.thebottomline.org.uk/summaries/em/proppr/) (2015) ; note that the [RePHILL](https://www.thebottomline.org.uk/summaries/icm/rephill/) trial did no support pre-hospital blood
- 4 bags (1 unit/bag) pRBC
- 4 bags (1 unit/bag) plasma
- 1 bag (4 uits/bag) platelets
# Indications for special preparations of pRBCs
![[Pasted image 20240224202203.png]]
# Predict massive transfusion in trauma
[Predict massive transfusion in trauma 2017](bookends://sonnysoftware.com/ref/DL/257901)
## ABC score
[ABC score 2009](https://pubmed.ncbi.nlm.nih.gov/19204506/)
**ABC score** (Assessment of Blood Consumption)
- SBP <90
- intrabdominal free fluid (positive FAST)
- Tachycardia >120
- penetrating mechanism
score 2 or more sensitivity of 75% and a specificity of 86% for MTT
## Other scores
![[Pasted image 20250714222035.jpg]]
> [!Caption] Table from [Predict massive transfusion in trauma 2017](bookends://sonnysoftware.com/ref/DL/257901)
***Notes:***
TASH - includes base excess >= 6 and unstable pelvis fracture or open/dislocated femur fracture
Revised massive transfusion score - includes base deficit, hypothermia, INR >1.5, Hb <11
* of note, base excess is in these, NOT lactate!
[TASH score 2006](https://pubmed.ncbi.nlm.nih.gov/16766965/)
# non-massive transfusion
see also: [[Blood transfusion]]
- Hb <70
- symptomatic anaemia (SOB, syncope) Hb 70-100
- <80 if co-morbidity (bone marrow supprision, heart failure)
- \>10 if RV failure
- \>90 if TBI (see [TRAIN study 2024](https://pubmed.ncbi.nlm.nih.gov/39382241/) )
# Related Questions
## blood transfusion
- [ ] 1Q: [Anaemia and Blood Transfusion](x-devonthink-item://662C8511-01CD-4659-B57D-5A01CF74D69B?page=12) -- [Answer](x-devonthink-item://79A95C0A-634E-4B38-9131-78949F63D56F?page=10) -- [prop](x-devonthink-item://F8FBC1E8-52B3-47B9-8EBB-5CB6F3F81EBC?page=13)
- [ ] 2Q: [Referral for Blood Transfusion](x-devonthink-item://7061D1B4-0AB9-4963-B3B0-23BDD975B2CD?page=38) -- [Answer](x-devonthink-item://3F30C77E-E23E-4200-89FE-48A41618E0C2?page=26)
- [ ] 3Q: [Anaemia](x-devonthink-item://8993893C-07A9-47B0-A68B-F8ED4C37C83D?page=18) -- [Answer](x-devonthink-item://C6A8980F-CAE5-458C-AC1E-FEBE553FDDE2?page=14)
## mass transfusion
- [ ] 5Q: [Abdominal aortic aneurysm](x-devonthink-item://EE8AC47E-BE40-4377-885E-FA9C91C8C262?page=3) -- [Answer]() -- [prop](x-devonthink-item://281EC7A9-8E5A-461A-AA34-3FF490AA0EC2?page=8)
- [ ] 6Q: [Paediatric Trauma](x-devonthink-item://B9F58929-18E6-4557-B393-263A6C98DFEF?page=2) -- [Answer](x-devonthink-item://DE4A2FC7-79D2-4B5D-805E-E481F1189654?page=1)
## mass transfusion protocol
- [ ] 7Q: [Massive Abdominal Wall Haematoma](x-devonthink-item://93BDB055-D606-4878-9FA5-0BEFF977FEF7?page=2) -- [Answer](x-devonthink-item://736EC9CD-AC9C-4588-BA1E-F4AD190CBA47?page=1)
- [ ] 8Q: [Pelvic trauma](x-devonthink-item://554C45F7-8661-4467-BD61-8A79B6ECABF4?page=20) -- [Answer](x-devonthink-item://554C45F7-8661-4467-BD61-8A79B6ECABF4?page=22)
- [x] 9Q: [Pelvic trauma](x-devonthink-item://4BE7EDE1-1843-4BA0-B8D2-0DCEF50784D4?page=10) -- [Answer](x-devonthink-item://15F8F701-8EC8-4F9A-8DEC-5220C8561C8A?page=9) -- [prop](x-devonthink-item://281EC7A9-8E5A-461A-AA34-3FF490AA0EC2?page=6)
- [ ] 10Q: [Pelvic trauma](x-devonthink-item://DE6BF2B6-53E9-4530-BC75-C00EC806A473?page=1) -- [Answer](x-devonthink-item://D25C2F83-6C30-4F45-8B5B-6E7E57BD24A3?page=10) -- [prop](x-devonthink-item://0F9688C6-AA10-45DA-BFF4-9BBBFC201582?page=8)
- [x] 11Q: [Variceal Upper GI Bleeding](x-devonthink-item://C1DDA3AB-2DA2-4922-A8A6-F597AB7E2558?page=16) -- [Answer](x-devonthink-item://A10DE51E-92FA-42D1-8AA0-7AE68C2FA743?page=18)
- [ ] 12Q: [Stab Wounds](x-devonthink-item://5ADC62A1-9798-4399-BE79-68C375E8D9BF?page=1) -- [Answer](x-devonthink-item://6F751245-A36C-447A-8AE7-599AD5871C71?page=19)
- [ ] 13Q: [Local Bar Shenanigans](x-devonthink-item://40F10AFA-5F29-4EE4-B149-300627B498B0?page=1) -- [Answer](x-devonthink-item://2088AEED-9FCF-4CF0-B58D-E4279D4BCC76?page=20) -- [prop](x-devonthink-item://5F365535-E019-4C8D-8402-2E764B328988?page=5)
- [ ] 14Q: [Fall From Ladder](x-devonthink-item://0987D972-A221-4F8A-B7D7-B0DCC349A2B3?page=1) -- [Answer](x-devonthink-item://C7FCB01A-E668-44AF-8C95-C298A40F8D68?page=0)
- [ ] 15Q: [Motorcycle Vs Kangaroo](x-devonthink-item://73409C77-B2FA-4E0A-AEB3-5EB284457F0C?page=36) -- [Answer](x-devonthink-item://5A848952-80E3-4184-B553-368412A69917?page=25)
## massive transfusion
- [ ] 16Q: [Motorbike accident](x-devonthink-item://1A2C485F-D4AD-4821-AFF2-452BA753717F?page=46) -- [Answer](x-devonthink-item://FD716379-1A77-4B5B-B257-1154995ECA6E?page=30) -- [prop](x-devonthink-item://1A2C485F-D4AD-4821-AFF2-452BA753717F?page=65)
## transfusion reaction
- [ ] 17Q: [Transfusion reaction](x-devonthink-item://707C2E83-C5B4-4D98-99ED-FC32BF6F417F?page=18) -- [Answer](x-devonthink-item://0C9617AB-8E16-4A75-ADF0-AB06FA726B0A?page=18)
- [ ] 18Q: [Abnormal FBC](x-devonthink-item://7E9EF652-F67B-42C5-A536-2EE85BA1954F?page=23) -- [Answer](x-devonthink-item://2DE5FACA-6D8F-41A2-8EAA-8DFE1E76FA61?page=14)
- [ ] 19Q: [Buttock Bruising](x-devonthink-item://CDB16617-3785-40E5-B8BE-5668D2D7A3E7?page=2) -- [Answer](x-devonthink-item://A6CA01E8-9551-45E7-8617-441BE3DBB5D7?page=1)