Massive hemorrhage protocol
|Massive hemorrhage protocol|
|Other names: Massive transfusion protocol (MTP)|
|Algorithm for a generic massive hemorrhage protocol|
Massive hemorrhage protocol (MHP), also known as massive transfusion protocol (MTP), is a technique used to treat people who have significant and ongoing bleeding. Such bleeding may occur during trauma or during pregnancy.
Aspects of management include identification of bleeding, getting and giving blood products, and stopping bleeding. Blood pressure may be allowed to remain relatively low in those without a head injury.
A massive transfusion may be defined as more than 3 units of packed red blood cells (PRBCs) in an hour. Other definition include more than half a persons blood volume in 4 hours; more than one blood volume in 24 hours; and more than 10 units of packed red blood cells in 24 hours.
Blood products may be given as 1 unit of PRBCs, 1 unit of fresh frozen plasma (FFP), 1 unit of platelets. Others give 2 units of PRBCs to 1 unit of FFP and 1 unit of platelets. After the first 30 to 60 minutes, which blood products are used may be based on repeated blood tests. Goals include keep hemoglobin between 80 to 120 g/L, platelets above 50 x 109, and INR under 1.8. In a GI bleed the goal is to keep the hemoglobin above 70 g/L. The patients blood values may be checked every hour.
Tranexamic acid 1 to 2 gram is recommended within three hours of injury or bleeding after delivery. A second gram is than given over 8 hours. It has not been found to be useful in gastrointestinal bleeding.
For those on anticoagulants reversal is often recommended. For warfarin reversal is with 10 mg of vitamin K intravenously together with 1,000 to 3,000 units of prothrombin complex concentrate (PCC). For dabigatran reversal is with idarucizumab 5 grams. And for a Xa inhibitor reversal is with 2,000 units PCC or andexanet alfa.
Other critical measures include keeping the person warm.
- Callum, Jeannie; Evans, Christopher C.D.; Barkun, Alan; Karkouti, Keyvan (5 June 2023). "Nonsurgical management of major hemorrhage". Canadian Medical Association Journal. 195 (22): E773–E781. doi:10.1503/cmaj.221731.
- "11". Massive hemorrhage and emergency transfusion. 7 September 2021. Archived from the original on 11 April 2023. Retrieved 2 July 2023.
- "Massive Transfusion Protocol (MTP)". EMCrit Project. Archived from the original on 7 March 2023. Retrieved 2 July 2023.