(P-TS-4) A Retrospective Review of Transfused Blood Components and the Outcome Following Activation of Massive Transfusion Protocol over a Ten-year Period in a Tertiary Hospital

Background/Case Studies: Massive Transfusion Protocol (MTP) is designed to provide quick and effective resuscitation to an actively bleeding patient by providing blood components in a predefined ratio to speed up transfusion to save life. While hospitals may formulate MTPs to guide their management of massive bleeding, the actual amount and types of blood components transfused ultimately may vary from patient to patient due to the underlying cause of bleeding and clinical assessment by the clinician.

Study

Design/Methods: This study reviews the outcome of blood components transfused upon activation of MTP from different categories of bleeding, its intended transfusion ratio and the mortality.

A retrospective review of the records of patients activated for MTP due to trauma, surgical, medical and obstetric bleedings in Singapore General Hospital (SGH) from 2015 to 2024 was performed. The MTP transfusion ratio was pre-set at 1:1:1, being 4 units of red blood cells (RBC), 4 units of fresh frozen plasma (FFP) and 4 units of platelets (PLT). Over a ten-year period, a total of 762 cases of MTP were activated and the types of blood components transfused were analyzed as to the average units per product used per case for the different categories and the ratios achieved.



Results/Findings: Of 762 MTP cases over ten years, 91 (12%) were due to trauma, 328 (43%) were surgical, 318 (42%) were medical and 25 (3%) were obstetric cases. The analysis of MTP usage of blood components over 10 years is shown in Table 1. The total RBC, FFP and PLT used were 5,763 units (average 7.56 per case), 4,323 units (average 5.67 per case) and 5,572 units (average 7.31 per case) respectively. This gave a transfusion ratio of RBC: FFP: PLT as 1: 0.75: 0.97 or 4:3:4, which was quite close to our pre-set MTP ratio, save for a 25% lower in FFP usage. This transfusion ratio remained similar when we looked at each of the separate categories of trauma, surgery, medical or obstetrics. Despite the higher percentage consumption of FFP compared to RBC or PLT, its contribution to the transfusion ratio was lower at 75%. The mortality rate for trauma, surgical, medical and obstetrics were 18%, 15%, 15% and none respectively. The mortality rate for trauma category was shown to be only 3% higher than surgical or medical cases.

Conclusions: Overall, the optimal transfusion ratio for MTP in our hospital was determined to be 4:3:4 based on our clinical usage and practice. The mortality rate for trauma category was slightly higher than medical or surgical categories which had similar mortality rate. Hospitals should formulate MTPs suited to their needs and resources to optimize blood usage while improving patient survival in massive blood loss.