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Hemorrhagic Shock and Massive Transfusion Protocol (1:1:1)

Balanced resuscitation in massive trauma or surgical bleeding; equal-ratio use of red blood cells, fresh frozen plasma, and platelets is essential.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Hemorrhagic Shock and Massive Transfusion Protocol (1:1:1)?

The Massive Transfusion Protocol (MTP) is designed to address requirements of 10 or more units of red blood cells in 24 hours or 4 or more units in 1 hour. The aim is to prevent the 'lethal triad' of coagulopathy, acidosis, and hypothermia.

Modern approach involves balanced administration of red blood cells, fresh frozen plasma, and platelets in a 1:1:1 ratio. Although the PROPPR trial did not show a statistically significant difference in 24-hour mortality, it improved hemostatic success.

Tranexamic acid (TXA) 1 g IV given within the first 3 hours reduces traumatic bleeding mortality (CRASH-2). Calcium replacement, hypothermia prevention, and viscoelastic blood tests (TEG/ROTEM) guide management.

Symptoms

Tachycardia, hypotension, cold periphery
Altered consciousness, restlessness
Pale skin, weak pulse
Oliguria or anuria
Capillary refill greater than 3 seconds
Shock index greater than 1
Elevated lactate, base deficit
Penetrating or blunt trauma

Risk Factors

Penetrating abdominal/thoracic trauma
High-energy traffic accident
Pelvic fracture
Postpartum hemorrhage
Massive GI bleeding
Anticoagulant use
Liver failure and coagulopathy
Prior cardiac surgery

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Shock index greater than 0.9 with active bleeding
  • Anticipated need for more than 10 units of blood
  • ABC score greater than or equal to 2 (FAST+, hypotension, tachycardia, penetrating mechanism)
  • Unstable hemodynamics with low Hb
  • Massive postpartum bleeding
  • Liver trauma and coagulopathy

Treatment Methods

01
MTP activation (blood bank notified)
02
1:1:1 RBC:plasma:platelet ratio
03
Calcium gluconate 1 g per every 4 units of blood
04
Tranexamic acid 1 g IV within first 3 hours
05
Hypothermia prevention (warming device)
06
Permissive hypotension (SBP 80-90 mmHg)
07
Surgical/angiographic hemorrhage control
08
TEG/ROTEM-guided therapy
09
Cardiac rhythm and electrolyte monitoring

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Acil Servis Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.