The document provides guidelines for managing massive blood transfusion or massive blood loss, defining it as replacing over 50% of total blood volume within 3 hours or 100% within 24 hours. It outlines the components of a massive transfusion protocol including blood products to transfuse and common complications to monitor for such as hypothermia, dilutional coagulopathy, and acidosis. The protocol is a multidisciplinary approach involving consultants, the blood bank, and laboratory to rapidly replace lost blood and clotting factors.

1. DIRECTOR : DR. S .C. GANESHPRABU M.D;D.A,
CHIEF :DR. SHANMUGAM M.D;DCH
ASSISTANT: DR.GANGANAGALAKHMI M.D;
DR. P.SALAMON RAJA PG

2.  Replacement of one entire blood volume within 24 h
 Transfusion of >10 units of packed red blood cells
(PRBCs) in 24 h
 Transfusion of >4 units of PRBCs in 1 h when on-going
need is foreseeable
 Replacement of 50% of total blood volume (TBV)
within 3 h.
 Definitions of MBT suggested for use in children are
transfusion of >50% TBV in 3 h, transfusion >100%
TBV in 24 h or transfusion support to replace on-going
blood loss of >10% TBV/min

3.  Physiologically, haemodynamic compensatory
mechanisms maintain vital organ perfusion till about
30% TBV loss, beyond which there is risk of critical
hypoperfusion. Inadequate resuscitation at this stage
leads to shock.
 It is important to remember that overzealous
resuscitation leading to high arterial and venous
pressures may be deleterious as it may dislodge
haemostatic clots and cause more bleeding.

4.  Blood component loss during massive blood loss is best
managed by following the massive transfusion protocol
(MTP).
 Mild to moderate blood loss can be managed with
crystalloid or colloid infusions alone. However, with
increasing loss, dilutional anaemia and later dilutional
coagulopathy sets in.
 Also, plasma substitutes may have direct effects on the
coagulation system particularly if used in volumes >1.5 L.
 A protocol based empirical replacement of coagulation
factors is, therefore, recommended in massive blood losses.

5.  it is a team work
 It consists of Consultant in Charge, blood bank,
laboratory.
 MTP pack
• 4 units PRBC, 4 units FFP, 1
pooled bag of platelets
OR
• 4 units PRBC, 4 units FFP, 6
units Cryoprecipitate.

7.  • Consider in life-threatening bleeding but note that this is
‘off label’ use. There has been no randomised trial
demonstrating a survival advantage of rFVIIa use in life-
threatening bleeding.
 • rFVIIa is most efficacious when every effort has been
made to correct surgical bleeding, hypothermia and
acidosis. In particular, patient pH should be > 7.2 for
procoagulant effect
 • Authorisation required by consultant haematologist on
call
 • Dose: 90 microg/kg, rounded to the nearest whole vial to
minimize wastage, given as an intravenous bolus. A second
dose may be required 2 hours after the first.

8.  Hypothermia
 Dilutional coagulopathy
 Hypocalcaemia
 hypomagnesaemia
 citrate toxicity
 Lactic acidosis
 Hyperkalaemia
 Air embolism

9.  Hypothermia
 Causes
 complications
 Management
 Dilutional coagulopathy
 Causes
 Management.

10.  Hyperkalemia
 Cause
 red blood cell membrane ATPase pump inactivation.
 Predisposing factors
 Hypokalemia
 Cause
 Hypocalcemia
 Cause
 Citrate toxicity
 Management

11. solution Elemental
calcium
Unit volume Total
elemental
calcium
osmolarity
10% calcium
chloride
27mg(1.36meq
)/ml
10ml ampule 270mg/10ml 2000 mosm/l
10% calcium
gluconate
9mg(.46meq)
/ml
10ml ampule 90mg /10ml 680mosm/l
10% calcium
chloride in
continuous
infusion
2.45 mg/ml 5 amps/500ml
NS
1350 mg/550
ml
200 mosm/l
10% calcium
gluconate
continuous
infusion
0.82mg/ml 5 amps/500ml
NS
450 mg/550
ml
200 mosm/l

12. Transfusion reactions (immune-
related reactions)
Nonimmune reactions
 Infections

13.  Non hemolytic fever reactions .
 Hemolytic transfusion reactions
 Immediate( acute)
 or
 delayed

14.  TACO
 TRALI
 ALLERGIC REACTIONS
 HYPOTENSIVE REACTIONS
 TAD
 POST TRANSFUSION PURPURA
 TA-GVHD
 HEMOSIDEROSIS
 TTI

15.  BACTERIAL CONTAMINATION
 VIRAL CONTAMINATION
 VARIANT CREUTZFELD JACOB DISEASE