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Massive Transfusion Protocol

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Bjorn dG

on 26 June 2013

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Transcript of Massive Transfusion Protocol

Massive Transfusion Protocol
1. Anticipate
Major Haemorrhage
INR level
2. Activate
3. MTP Packs
Additional Products
4. Reassess
Consider Tranexamic Acid
rFVIIa (Novoseven)
5. Bleeding Suppressed?
Repeat MTP Pack 2 as required
Repeat Lab Tests
Consider second dose of rFVII (Novoseven)
______________________________________________
Initial Management
Activate MTP -
Notify Blood Bank ext 8352
Nominate a Haemostasis Leader
Dedicated Courier
Send Lab test samples ASAP and collect blood products
Call for Emergency Blood
Consider presence of anticoagulants
Specimens Collection
Administer Emergency Blood Products -
Notify Blood Bank ext 8352
_______________________________________________________
Treating Team Responsibilities
Repeat blood tests every 30 - 60 mins
Check all blood on arrival
Use Blood Warmer
Document all blood products given
Notify Blood Bank when patient transferred
Return and store unused blood products appropriately
FFP x 4 units
Cryo x 3 units
Platelets x 1 dose
MTP Pack 1
RBC, FFP, Cryo
Repeat Lab Tests
MTP Pack 2
RBC, FFP, Platelets
Repeat Lab Tests
YES
NO
6. Cease MTP
Haemostasis Leader to -
Notify Blood Bank ext 8352 to Cancel MTP Packs
Questions?
Bjorn De Guia
Complications of Massive Transfusion
Blood Volume Replacement
Thrombocytopenia
Coagulation Factor Depletion
O2 Affinity Changes
Hypocalcaemia
Hyperkalaemia
Acid/Base Disturbances
Hypothermia
ARDS
for Adults / Obstetrics
RED May 2013
Summary
Sequence of Components
Profound hypotension should be treated speedily. Administer crystalloid or colloid infusions rather than delay fluids administration.
Lab Samples
At the start of resuscitation, blood should be taken for group and crossmatch, coagulation tests, FBC and biochemistry. These must be labelled and identified in all situations.
Blood Bank Arrangements
Routine procedures should be followed until it becomes obvious that massive transfusion is likely. The blood bank should be informed ASAP that a patient (hypovolaemic) is arriving or in the dept.
For extreme emergencies group O blood should be supplied first. Rh D neg blood should be supplied to all women of childbearing age. Type specific (ABO Rh D matched) blood should be available ASAP and switch should be made promptly so as not to deplete stores of group O blood. Continue transfusing blood on this basis until time is available to crossmatch on the original serum sample.
For massive uncontrolled haemorrhage, the priority is for definitive surgical intervention. Conbination of stored blood, colloid and crystalloid are given to maintain blood volume or pressure at adequate levels.
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