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Application of massive transfusion protocol is associated with a low incidence of coagulopathy and mortality rate


Khalafallah, A and Al-Barzan, AM and Ganguly, A and Bates, G and Gavin, F and Ahuja, KDK and Seaton, D and Brain, T, Application of massive transfusion protocol is associated with a low incidence of coagulopathy and mortality rate, Journal of Blood Disorders and Transfusion, 3, (3) pp. 1-5. ISSN 2155-9864 (2012) [Refereed Article]


Copyright Statement

Copyright 2012 Khalafallah A, et al. Licenced under Creative Commons Attribution 3.0

DOI: doi:10.4172/2155-9864.1000123


Background: Massive haemorrhage and subsequent Massive Transfusion (MT) are associated with serious, often fatal complications including intractable Disseminated Intravascular Coagulation (DIC). Historically undesirable outcomes demonstrate the need to improve the management approach of MT. It is clear that evidence-based guidelines and protocols should be developed with the aim of improving MT-outcome. Methods: We implemented an evidence-based MT-Protocol (MTP) in 2007 and studied all patients (105) from Jan 2008 to Jan 2011 who required MT and were treated with the MTP at our institution. The MTP includes two phases and incorporates a fixed volume of Fresh Frozen Plasma (FFP), cryoprecipitate and platelets in addition to Packed Red Blood Cells (PRBC). Results: The median age of patients was 57 years (range, 18-86). The male to female ratio was 74:31. Median Hb was 90 g/L (range, 44-110) and platelet count was 190/nl (range, 34-817). Thirteen patients developed mild DIC; 22 moderate DIC and one severe DIC. D-dimer showed average increase of 7.9 mg/L with a range between 0.6-35 mg/L (Normal <0.5). Average INR was 1.97, (range, 1.2-7.2), while average APTT was 36 seconds (range, 22-88s). The mortality rate was 11.4% (12/105) and these were mainly related to underlying trauma rather than DIC with the exception of 1 patient. The average number of transfused PRBC was 15 units (range, 6-42); cryoprecipitate, 20(range, 10-60); platelets, 2(range, 1-7) and FFP, 8(range, 2-20). Conclusion: Despite serious bleeding secondary to trauma or surgery, the implementation of MTP seems to have reduced the occurrence of severe DIC and was associated with a relatively low mortality-rate. Further studies to confirm these findings are warranted.

Item Details

Item Type:Refereed Article
Keywords:Massive transfusion protocol; Massive haemorrhage; Trauma; Surgery; Coagulopathy; Outcome
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Haematology
Objective Division:Health
Objective Group:Clinical health
Objective Field:Diagnosis of human diseases and conditions
UTAS Author:Khalafallah, A (Professor Alhossain Khalafallah)
UTAS Author:Al-Barzan, AM (Dr Abdul Majeed)
UTAS Author:Bates, G (Mr Gerald Bates)
UTAS Author:Ahuja, KDK (Dr Kiran Ahuja)
ID Code:80058
Year Published:2012
Deposited By:Health Sciences A
Deposited On:2012-10-19
Last Modified:2017-05-29
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