Confusion surrounding trauma resuscitation and opportunities for clarification

In the absence of low-titer group O whole blood, conventional components are often transfused to hemorrhaging trauma patients in a ratio designed to replicate whole blood. However, there is still confusion surrounding how conventional components should be used to support traumatically injured bleeding patients, particularly concerning how platelets should be counted in a ratio-based approach and when the resuscitation can switch from a ratio-based to a laboratory-guided approach.

A traumatically injured patient, who was resuscitated with 10 units of red blood cells (RBCs), 6 units of plasma, 2 units of apheresis platelets, and 5 pools of cryoprecipitate is described. After hemostasis was achieved, and in the setting of an international normalized ratio of 1.2, the clinical team requested 4 additional units of plasma because "the patient was not resuscitated with a 1:1 ratio of RBCs to plasma." This case illustrates that misconceptions surrounding resuscitation with conventional components may lead to unnecessary transfusions in patients with normal laboratory values who have achieved hemostasis.

This report provides clarification as to how conventional components can be used for trauma resuscitation and why there is no need to transfuse additional plasma-containing components to achieve a desired ratio when the patient is no longer bleeding and laboratory values are within normal limits. Furthermore, each dose of platelets is suspended in roughly the equivalent of 1 additional unit of plasma that should also be considered in the cumulative dose of plasma administered when using a ratio-based approach.