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Massive Transfusion
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Transfusion Medicine Service Massive Transfusion Protocol (MTP)

Further information is available by contacting the Medical Director of the Transfusion Medicine Service: Zbigniew.M.Szczepiorkowski, MD or the Blood Bank Medical Director, Nancy Dunbar M.D.
Identification of MTP Candidates:
  • Life threatening trauma presenting to the Emergency Room – see Trauma Activated Transfusion Algorithm TATA information link
  • Unexpected surgical blood emergencies
  • Medical Emergencies potentially requiring extensive blood support

The identification of candidates is made by the responsible Surgical or Anesthesia staff. The protocol is automatically activated by the Blood Bank on transfusion of a volume of red cells equal to the patient's red cell mass within a 24 hour period.

Notification of Transfusion Service

The physician, or designee, responsible for the potential MTP candidate shall notify the Blood Bank (5-7207) that MTP is indicated. The Blood Bank will contact the Transfusion Medicine Physician.

Once the MTP is Activated

The Transfusion Medicine Physician shall proceed to the involved patient's location, notify the clinical staff in person, and supervise the transfusion needs of the patient from that point forward until, by agreement with the patient's physician, the MTP emergency is declared to be at an end. The MTP provides a coordinated hematologic resuscitation effort, including the use of thawed plasma, cryoprecipitate, platelets, and red blood cells. Prioritization, coordination, and monitoring of laboratory tests are another element of the MTP.
Note:  O Rh negative or O Rh positive units may be sent based upon patient status, gender, and age.


Transportation of blood components is coordinated by the local unit, using unit based runners or via Supply Chain Management (Patient Transportation/Distribution). If the unit is unable to contact Supply Chain Management to arrange for STAT transportation of blood products during the MTP, the unit will request that the Blood Bank notify the dispatcher for Supply Change Management. The OSC (Outpatient Surgery Center) will be responsible to provide their own couriers.


The goals of the MTP are:

  1. To focus responsibility for guidance of blood resuscitation on the Transfusion Medicine Service Physician
  2. To standardize laboratory monitoring for the benefit of clinical staff in crisis situations
  3. To provide optimal blood component therapy for critically ill patients

Specific Protocol Guidelines

  1. Role of Surgical - Medical Team
      Obtain tests as indicated by the case
      Obtain laboratory consultation for known coagulopathies pre-MTP
      Notify the Blood Bank of potential MTP

  2. Role of Anesthesia Service

    1. Repeat specific coagulation tests after appropriate factor replacements
      Order specific blood components via eD-H

  3. Role of the Transfusion Medicine Physician
      Manage hematologic replacement therapy
      Direct Clinical Laboratory Sections to obtain top priority for tests in support of the patient

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