When transfusing massive amounts of blood, what is the optimum ratio of platelets to red blood cells in order to decrease the risk of coagulopathy and hemorrhage?

Holcomb JB, et al.  Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients.  Ann Surg. 2008 Sep;248(3):447-58.

Several recent retrospective studies addressed this question, but this one had

  1. A well-defined population:  adult trauma patients at multiple level 1 trauma centers, who arrived from the scene and received at least 1 unit of RBC in the ED, July 2005-June 2006
  2. Similarity in baseline characteristics of the groups (mean INR, pH, injury severity scores, age, admission platelet counts) except for mean admission systolic blood pressure

Short answer: Survival in massive transfusion patients is associated with increased plasma and platelet ratios.

Records of 467 MT trauma patients transported from the scene to 16 level 1 trauma centers between July 2005 and June 2006 were reviewed. One patient who died within 30 minutes of admission was excluded.  Outcomes were 6 hour, 24 hours and 30 day mortality.

Figure 2 compares the 24 hour survival by 4 groups by transfusion ratios:  high FFP & high platelets to RBCs, high FFP & low platelets to RBCs, low FFP & high platelets to RBCs, and low FFP & low platelets to RBCs.

Table 4 includes a comparison of the groups by cause of death.  The group receiving the high ratio of FFP & high ratio of platelets to RBCs had the smallest rate of death by truncal hemorrhage.


About Amy

Clinical Informationist at EUH Branch Library
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