II. Indications

  1. Trauma with Hemorrhage requiring transfusion of >2-4 units Packed Red Blood Cells

III. Mechanism

  1. Coagulopathy develops with Massive Blood Transfusion (dilution of Coagulation Factors)

IV. Protocol

  1. Ratio of 1:1:1 of platelets : plasma : Red Blood Cells is preferred (decreased mortality compared with 1:1:2)
    1. Replace 1 unit of plasma for every 1 unit of Packed Red Blood Cells (pRBC)
    2. Replace 1 unit of apheresis platelets for every 6-8 units of Packed Red Blood Cells
      1. Each unit of apheresis platelets is equivalent to prior platelet 6-pack
  2. Consider Prothrombin Complex Concentrate (PCC) 1-2 doses
    1. Do not use beyond 6-7 hours from bleeding onset (due to increased bleeding risk)
  3. Consider Tranexamic Acid

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