Background/Case Studies: Massive transfusion protocols (MTPs) are critical for reducing hemorrhagic mortality in critically bleeding patients, however data on real-world compliance, blood-product utilization patterns and product wastage are limited.
Study
Design/Methods: We conducted a retrospective review in a single centre, 700 bed acute general hospital, of all MTP activations from 1 January 2017 to 31 December 2024. Data extracted from electronic medical records and blood-bank database included patient demographics, indication for activation, activation authorisation by attending physician, ABC (Assessment of Blood Consumption) score at activation, component units transfused - red blood cells (RBCs), frozen plasma (FP), platelets (PLT), cryoprecipitate (CRYO) - and instances of unused thawed products (“wastage”) and 24-hour survival. Descriptive statistics summarized categorical data as counts and percentages, and continuous variables as medians and interquartile ranges (IQR).
Results/Findings: A total of 128 MTP activations were identified (median age 65 y, IQR 46–84; 69.6 % male), the majority were Chinese (62.5%) with blood groups O POS (34.4%) or A POS (30.5%). Gastroenterology (49.2%) and trauma (27.3%) were the leading specialties in MTP utilization. Protocol activation complied with authorized-physician requirement occurred in 81.4 % but there was low ABC-scoring compliance of 11.2%. A total of 161 MTP packs were activated with majority not proceeding beyond Pack 2: Pack 1 accounted for 80.1% and Pack 2 12.7%. Complete utilization occurred in 63.4% of activations (Pack 1: 81.4%; Pack 2: 12.7%; Pack 3: 5.9%). Only 41.6% of cases achieved the target 1:1 RBC:Plasma ratio. Across all on-campus transfusions, MTP accounted for 1.1% of RBC, 8.7% of FP, 3.5% of platelets, and 6.2% of cryoprecipitate. Wastage rates were highest for cryoprecipitate (90.0%), FP (47.1%), and platelets (30.0%). Twenty-four-hour survival post-MTP was 74.2%. Conclusions: Our eight-year audit demonstrates good compliance with MTP activation. Significant opportunities exist to improve ABC‐score utilization, pack‐ratio compliance, and blood-product stewardship, particularly to reduce cryoprecipitate and FP wastage. Targeted education and real-time decision support may enhance protocol adherence and optimize resource use in future MTP implementations. These findings can also guide protocol refinement in comparable tertiary centres across the country.
