Massive transfusion: changing practice in a single Norwegian centre 2002-2015

To describe the change in massive transfusion (MT) practice in a single Norwegian centre throughout the period 2002-2015.

MT support for traumatic haemorrhage has changed since the mid-2000s. However, life-threatening haemorrhage may occur in other clinical specialties. In 2007, Haukeland University Hospital (HUS) introduced a universal MT programme including education, Acute Transfusion Packages (ATPs) and thromboelastography.

A retrospective review was performed of all MT episodes defined as ≥10 red cell concentrates (RCC) in 24 h. Episodes were identified using the laboratory information system. Patient records were reviewed manually for demographics, transfusion indication, haemostatic drugs and mortality. The ATPs contained six units RCC, six units Octaplas and two platelet concentrates (four buffy coats/apheresis in platelet additive solution (PAS)).

A total of 410 episodes were identified in 410 patients. The mean patient age was 60 years (9-94), with a male predominance (64%); 87·1% of MT episodes were in support of surgery (cardiac services 42·7%; trauma 17·6%), and 29·8% of MTs involved platelet inhibitors, with 82·6% of these undergoing cardiac procedures. MT accounted for 2·8% of all RCCs and 3·4% of platelets issued. The mean ratio of blood components RCC: plasma: platelets changed from 1·0 : 0·37 : 0·39 in 2002-2006 (n = 149) to 1·0 : 0·79 : 0·85 in 2008-2015 (n = 241, P < 0·001). A sub-analysis showed that cardiac specialities used proportionally more plasma and platelets.

The MT programme changed transfusion practice, resulting in greater use of plasma and platelets. MT was primarily used in major surgery. The practice in cardiac surgery may reflect changes in antiplatelet medication.