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Updated: Mar 8, 2026
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Early high ratio platelet transfusion in trauma resuscitation and its outcomes
Ruben Peralta1, Adarsh Vijay2, Ayman El-Menyar3
1Department of Surgery, Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar; University National Pedro Henriquez Urena, Department of Surgery, Santo Domingo, Dominican Republic, Doha, Qatar.
Insights
Achieving a high platelet (PLT) to packed red blood cell (PRBC) ratio early in massive transfusion protocols (MTP) for trauma patients significantly reduces multiple organ failure and mortality. This early high PLT:PRBC ratio is crucial for better trauma patient outcomes.
Area of Science:
- Trauma critical care
- Transfusion medicine
- Hemorrhagic shock management
Background:
- The optimal platelet (PLT) to packed red blood cell (PRBC) ratio in massive transfusion protocols (MTP) for trauma patients remains debated.
- This study investigates the impact of achieving a high PLT:PRBC ratio (≥1:1.5) within 4 hours post-injury on trauma patient outcomes.
Purpose of the Study:
- To determine the effect of an early high PLT:PRBC ratio on outcomes in trauma patients undergoing MTP.
- To compare outcomes between trauma patients receiving a high PLT:PRBC ratio (HMTP) versus a low PLT:PRBC ratio (LMTP) within 4 hours of injury.
Main Methods:
- Retrospective review of adult trauma patients who received MTP over a 24-month period.
- Data analyzed based on PLT:PRBC ratio achieved within 4 hours post-injury (HMTP ≥1:1.5 vs. LMTP <1:1.5).
- Comparison of baseline characteristics, complications, and outcomes between HMTP and LMTP groups.
Main Results:
- Of 3244 trauma patients, 58 (1.2%) met inclusion criteria for ratio analysis.
- The high PLT:PRBC ratio group (HMTP) showed significantly higher rates of ventilator-associated pneumonia and wound infection.
- However, HMTP was associated with significantly lower rates of multiple organ failure (MOF) and 30-day mortality compared to LMTP.
Conclusions:
- Early achievement of a high PLT:PRBC ratio (≥1:1.5) within 4 hours post-injury is significantly associated with reduced MOF and mortality in trauma patients.
- This finding supports the early administration of platelets in MTP for severely injured patients.
Introduction:
The optimal ratio of platelets (PLTs) to packed red blood cell (PRBC) in trauma patients requiring massive transfusion protocol (MTP) is still controversial. This report aims to describe the effect of attaining a high PLT:PRBC ratio (≥1:1.5) within 4 h postinjury on the outcomes of trauma patients receiving MTP.
Methods:
Over a 24-month period, records of all adult patients with traumatic injury who received MTP were retrospectively reviewed. Data were analyzed with respect to PLT:PRBC ratio ([high-MTP ≥1:1.5] [HMTP] vs. [low-MTP <1:1.5] [LMTP]) given within the first 4 h postinjury and also between (>4 and 24 h). Baseline demographic, clinical characteristics, complications, and outcomes were compared according to HMTP and LMTP.
Results:
Of the total 3244 trauma patients, PLT:PRBC ratio was attainable in 58 (1.2%) patients who fulfilled the inclusion criteria. The mean age was 32.3 ± 10.7 years; the majority were males (89.6%) with high mean Injury Severity Score (ISS): 31.9 ± 11.5 and Revise Trauma Score (RTS): 5.1 ± 2.2. There was no significant association between age, gender, type of injury, presenting hemoglobin, International Normalized Ratio, ISS, and RTS. The rate of ventilator-associated pneumonia (38.9% vs. 10.8%; P = 0.02) and wound infection (50% vs. 10.8%; P = 0.002) were significantly higher in the HMTP group. However, HMTP was associated with lower rate of multiple organ failure (MOF) (42.1% vs. 87.2%, P = 0.001) and mortality (36.8% vs. 84.6%, P = 0.001) within the first 30 days postinjury.
Conclusions:
Our study revealed that early attainment of high PLT/PRBC ratio within 4 h postinjury is significantly associated with lower MOF and mortality in trauma patients.
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