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Transfusion Service - Trauma and Massive Transfusion Practices

(P-TS-78) Massive Transfusion Protocol (MTP) Activation- Lessons Learned. a Prospective Audit for Implementing Patient Blood Management (PBM) in a Level 1 Trauma Centre, India

Sunday, October 26, 2025
12:00 PM - 1:00 PM  PT
Background/Case Studies: Despite established benefits, inconsistencies in MTP activation, blood component utilization, and outcomes persist. With 7,000+ annual blood requests, this audit was aimed to implement PBM through gap analysis, improve transfusion efficiency through analyzing errors encountered, alloimmunization, false activation of MTP and wastage calculation.

Study

Design/Methods: A prospective observational study was conducted from January to December 2024 in our Level 1 trauma centre in Northern India. Inclusion criteria were patients with hemodynamic instability, ongoing bleeding, ABC score >2, requiring >4 PRBC units/hour. MTP blood packs used were: Pack A (O positive PRBC, AB positive FFP, RDP) and Pack B (O negative PRBC, AB positive FFP, RDP), in a 1:1:1 ratio.

Results/Findings:


  • A total of 318 patients received MTP for 1 year



  • Most patients were aged 21–30 years (82% males)



  • Polytrauma (66%), arterial rupture (18%), and multiorgan injuries (8%) were the main causes



  • MTP Activations peaked between 2 PM–8 PM (60%), significantly more than other times (χ²=118.10, p< 0.05).



  • All cases were given 1gm tranexamic acid and supportive measures



  • Crossmatch details




    • 311 (97.7%) patients received packs without crossmatch




      • 212 (66.6%) pack A



      • 8 (2.5%) pack B




    • Group specific saline crossmatch -2 (0.6%)



    • AHG crossmatch- 5 (1.5%)




  • Among 224 (70.4%) patient’s blood group was unknown. A statistically significant (< 0.05) association between blood group status (known vs unknown) and crossmatch type used. (𝞆2- 17.06, p value- 0.0002)



  • Median duration of MTPs was 59 minutes (mean 88 minutes) with a range of 0-12.25 hours (right-skewed data,W statistic: 0.904 p-value: < 0.00000000000023)



  • A statistically significant difference in MTP durations between patients with known and unknown blood groups (U statistic: 8834.0, p-value: 0.0236)


  • Subanalysis and outcomes are included in Table 1



Conclusions: MTP activations often involved uncrossmatched blood and occurred outside peak working hours, highlighting need for rapid decision making and around-the-clock preparedness. False activations and product returns emphasized the need for stringent clinical criteria. Alloimmunization, pre analytical error and transfusion reactions necessitate continued vigilance. Underutilization of cryoprecipitate requires addressing. Continuous staff training, strict protocol adherence, and enhanced awareness will be crucial for optimizing trauma transfusion practices.