Any changes in recent massive transfusion practices in a tertiary level institution?

Area of Science:

• Transfusion Medicine
• Critical Care Medicine
• Emergency Medicine

Background:

• Previous review (1998-2008) indicated rising ratios of red cells to plasma and platelets.
• This study aimed to further evaluate transfusion practices and outcomes in massive transfusion (MT).

Purpose of the Study:

• To analyze blood product usage and patient outcomes in massive transfusions (MT).
• To compare transfusion practices and outcomes over time, including the use of massive transfusion protocols (MTP) and viscoelastic hemostatic assays (ROTEM).

Main Methods:

• Retrospective analysis of adult patients receiving MT (≥10 units of red cells in 24h) in 2008 and 2010-2014.
• Evaluation of blood products transfused, in-hospital mortality, and 24h/90-day mortality.
• Comparison of MTP activation and ROTEM use between 2008 and 2014.

Main Results:

• 190 MT episodes identified (2010-2014), predominantly in surgical patients (52.1%).
• Overall in-hospital mortality was 26.7%, with significant differences between diagnostic groups.
• No significant change in median red cell, plasma, or platelet units, but increased cryoprecipitate use (54.5% vs 87%, p=0.01) by 2014.

Conclusions:

• Transfusion practices continue to evolve towards increased plasma and cryoprecipitate use.
• Higher red cell to fresh frozen plasma ratios are being employed.
• These trends support the principles of haemostatic resuscitation in managing critical bleeding.