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Updated: Feb 11, 2026

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

H Doughty1, T O Apelseth2,3, J Sivertsen2

  • 1NHS Blood and Transplant, Birmingham, UK.

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|April 24, 2018
PubMed
Summary

Massive transfusion (MT) protocols increased the use of plasma and platelets, primarily in major surgery. This shift in transfusion practice was observed following the implementation of a new MT program in a Norwegian hospital.

Keywords:
acute transfusion packageblood component therapymassive transfusionred cell: plasma: platelet ratio

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Area of Science:

  • Transfusion Medicine
  • Hemorrhage Management
  • Critical Care

Background:

  • Massive transfusion (MT) protocols have evolved, particularly for traumatic hemorrhage.
  • Life-threatening bleeding occurs across various clinical specialties beyond trauma.
  • Haukeland University Hospital (HUS) implemented a universal MT program in 2007, including education, Acute Transfusion Packages (ATPs), and thromboelastography.

Purpose of the Study:

  • To evaluate changes in massive transfusion (MT) practices.
  • To analyze transfusion trends between 2002 and 2015 at a single Norwegian center.
  • To assess the impact of a universal MT program on transfusion component ratios.

Main Methods:

  • Retrospective review of all MT episodes (≥10 red cell concentrates in 24 hours).
  • Data collected via laboratory information systems and manual patient record review.
  • Analysis of patient demographics, transfusion indications, use of hemostatic drugs, and mortality.

Main Results:

  • 410 MT episodes in 410 patients were identified; mean age 60, 64% male.
  • 87.1% of MT episodes supported surgery, with cardiac services (42.7%) and trauma (17.6%) as primary indications.
  • The ratio of red cell concentrates (RCC) to plasma to platelets shifted significantly from 1:0.37:0.39 (2002-2006) to 1:0.79:0.85 (2008-2015), with cardiac surgery using proportionally more plasma and platelets.

Conclusions:

  • The implemented MT program successfully altered transfusion practices.
  • Increased utilization of plasma and platelets was observed post-program implementation.
  • MT was predominantly used in major surgical procedures, particularly cardiac surgery, potentially influenced by antiplatelet medication trends.