UMEM Educational Pearls

Category: Critical Care

Title: Massive Transfusion Pearls

Posted: 4/16/2013 by Mike Winters, MD (Emailed: 4/17/2013)
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Massive Transfusion Pearls

  • As discussed in previous pearls, massive transfusion (MT) is defined as the transfusion of at least 10 U of packed red blood cells (PRBCs) within 24 hours.
  • While the optimal ratio of PRBCs, FFP, and platelets is not known, most use a 1:1:1 ratio.
  • Though scoring systems have been published to identify patients who may benefit from MT (ABC, TASH, McLaughlin), they have not been shown to be superior to clinical judgment.
  • A few pearls when implementing massive transfusion for the patient with traumatic shock:
    • Monitor temperature and aggressively treat hypothermia.
    • Monitor fibrinogen levels and replace with cryoprecipitate if needed.
    • Monitor calcium and potassium.  MT can induce hypocalcemia and hyperkalemia.


Elmer J, et al. Massive transfusion in traumatic shock. J Emerg Med 2013; 44:829-838.