Massive Transfusions

July 11th, 2013

The JPS method of treating trauma patients requiring massive blood transfusions has contributed to higher-than-average survival rates for JPS patients and will be presented on a national stage this fall. Flo Shaw, supervisor of the Blood Bank, will present the Massive Transfusion Protocol at the annual meeting of the American Association of Blood Banks in Denver in October.

Shaw submitted two abstracts describing the development and decade-long evolution of the Massive Transfusion Protocol, inspired by a patient who slashed her own jugular vein. The patient survived, but "it became apparent during the management of the patient that we needed to improve communication between departments and the blood bank and also set protocols for the quantity and type of blood products to issue and at what intervals," Shaw recalled.

Massive transfusion is typically defined as replacement of the body's entire blood volume - about 5 liters, or 10 units - within 24 hours. Managing patients facing imminent death from blood loss is a precarious balancing act. Blood volume must be maintained to protect the brain and major organs, but flooding the circulatory system with red blood cells can trigger complications just as deadly, in the end, as blood loss. And minutes count. If blood products are not at the ready, the time it takes to relay a physician's order, prepare them for transfusion and transport them from the blood bank can seal a patient’s fate. JPS had 73 mass transfusion patients in 2012. As of the end of May, there have been 35 so far this year.

The JPS protocol was developed and is frequently reviewed by team members from every department involved with massive transfusion patients, including Trauma, Surgery, Nursing and the Blood Bank. It calls on physicians to initiate preparation of blood products while patients are still en route, and dictates the mix of red blood cells, fresh frozen plasma and single-donor apheresis platelets to be delivered from the Blood Bank in cycles that repeat until the patient's bleeding is controlled. It also dictates when and which blood tests will be done to type the patient's blood and measure clotting factors.

"By evaluating the mass transfusion protocol and utilizing the most up to date testing methodologies, patient outcomes have improved," Shaw wrote. The mortality rate for the most critically injured trauma patients at JPS is 19.9 percent. The most recent national average is 28.1 percent, according to the National Trauma Data Bank.