Assessing response to changing plasma/red cell ratios in a bleeding trauma patient.

Area of Science:

• Trauma and Emergency Medicine
• Transfusion Medicine
• Hematology

Background:

• Massive transfusion protocols (MTPs) are crucial for managing exsanguinating trauma patients.
• Recent military data suggest a 1:1 ratio of fresh frozen plasma (FFP) to packed red blood cells (PRBC) may improve survival.
• Optimal FFP:PRBC ratios in civilian trauma remain under investigation.

Observation:

• This case report details a patient with a gunshot wound requiring massive transfusion.
• Initial FFP:PRBC ratios of 1:2 and 4:5 failed to correct coagulopathy and control bleeding.
• The patient received recombinant activated factor VII, which normalized INR and factor VII levels.

Findings:

• A subsequent FFP:PRBC ratio of 7:5 led to normalization of most laboratory parameters of coagulopathy.
• Factor V levels showed improvement.
• Clinical cessation of bleeding was achieved with the 7:5 FFP:PRBC ratio.

Implications:

• The findings suggest that higher ratios of FFP to PRBC may be necessary in certain massive transfusion scenarios.
• Individualized adjustments to transfusion ratios might be required based on patient response.
• Further research is warranted to establish optimal FFP:PRBC ratios in civilian trauma management.