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Massive Transfusion Protocol

Department

Blood Bank

Instructions

• It is of utmost importance to call the Blood Bank immediately when initiating this protocol to facilitate immediate blood product preparation. The only way to initiate this protocol is by contacting the Blood Bank directly. Order a Type and Screen immediately.
• An authorized clinician may request this protocol and their signature will be required (it is acceptable to sign after the event)

Specimen Collection Criteria

• No specimen is required to initiate the Massive Transfusion Protocol, but it is required in order to provide crossmatch compatible products.
• The Request for Emergency Dispense of Uncrossmatched Blood Product Form (Form #1565) must be completed and delivered to the Blood Bank for blood product dispensing.
• Without a completed Type and Screen, Emergency Issue of Blood & Blood Products will be provided until the Type and Screen is completed.
• A Type and Screen specimen should be collected as soon as possible and preferably prior to the administration of uncrossmatched blood products.
  • Collect: One Pink-top EDTA tube, properly labeled. (Minimum Volume: 5.0 mL)
  • Also acceptable: (For Nursery Patients) One Pink-top EDTA Microtainer®, properly labeled. (Minimum Volume: 0.5 mL)  

Laboratory

Farmington Hills Transfusion Medicine Laboratory (Blood Bank)
Grosse Pointe Transfusion Medicine Laboratory (Blood Bank)
Royal Oak Transfusion Medicine Laboratory (Blood Bank)
Troy Transfusion Medicine Laboratory (Blood Bank)
Dearborn Transfusion Medicine Laboratory (Blood Bank)
Taylor Transfusion Medicine Laboratory (Blood Bank)
Trenton Transfusion Medicine Laboratory (Blood Bank)
Wayne Transfusion Medicine Laboratory (Blood Bank)

Performed

• This protocol is performed STAT.
• Uncrossmatched RBC blood products are available immediately
• Immediate platelet and thawed plasma availability varies by hospital..
• Crossmatch compatible blood products will be available once the Type and Screen is completed and on file in the Blood Bank.
• If a patient has unexpected clinically significant red cells antibodies there may be more time required to obtain crossmatch compatible blood for the patient.

Test Methodology

• Massive Transfusion Protocol consists of blood products issued in the ratio of 6 Red Blood Cell units, 6 plasma units, and 1 platelet pheresis/pooled unit. Cryoprecipitate pool may be ordered separately as needed. The Blood Bank will notify the nursing unit when each set of products is ready. Sets of products will continue to be replenished as they are used until the protocol is terminated by the clinical team.
• Additional products will be available upon request.

Interpretation

• Additional time is necessary to crossmatch red blood cells for patients with clinically significant antibodies. All efforts will be made to provide blood as quickly as possible.
• Positive antibody screens will be communicated to the nursing staff by telephone.

Clinical Utility

• The Massive Transfusion Protocol is used to provide blood products as quickly and efficiently as possible to a patient who is exsanguinating due to physical trauma or unexpected massive bleeding during a surgical procedure or delivery of an infant.
• The Blood Bank and the surgical team will work together to provide appropriate products to the patient to support:
  • Fluid resuscitation (volume)
  • Red cell mass replacement (to maintain tissue oxygenation)
  • Platelet and coagulation factor replacement to prevent dilutional coagulopathy (to counteract depletion resulting from consumption and dilution)

CPT Codes

Codes as required for blood products appropriate for the patient.

Contacts

Last Updated

9/29/2023