title: Transfusion practice in massively bleeding patients: time for a change?
abstract: OBJECTIVE
  We identified some fatal cases where massively bleeding patients received inadequate transfusion therapy. The aim of this study was to review and evaluate the transfusion practice in acutely multitransfused patients.
  
  
  METHODS
  Patients receiving > 10 units of red blood cells (RBC) within 24 h of admission and 30 blood components within 7 days of admission were reviewed.
  
  
  RESULTS
  Thirty-nine patients were identified, 13 of whom were inadequately transfused (IT) and had a higher mortality (12/13) than adequately transfused (AT) patients 13/26 (P = 0.013). Ten of 13 IT patients developed a microvascular bleed compared to four of 26 in the AT group (P = 0.001) and had a lower platelet count upon arrival at the intensive care unit (40 x 10(9)/l vs. 80 x 10(9)/l, P = 0.024).
  
  
  CONCLUSIONS
  An early balanced transfusion therapy is vital in massively bleeding patients, and a pro-active approach from the blood bank is warranted. We have introduced an acute transfusion package (ATP) consisting of 5 RBC, 5 FFP and 2 PC units, indicated in massively bleeding patients, securing a balanced transfusion therapy.
authors.affiliation: Department of Clinical Immunology, University Hospital of Copenhagen, Copenhagen, Denmark. p.johansson@post.tele.dk
authors.forename: P I
authors.initials: PI
authors.lastname: Johansson
authors.forename: M B
authors.initials: MB
authors.lastname: Hansen
authors.forename: H
authors.initials: H
authors.lastname: Sørensen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001771:Blood Banks; D016913:Blood Component Transfusion; D001803:Blood Transfusion / Q000379:methods* / Q000639:trends; D017707:Erythrocyte Transfusion; D004912:Erythrocytes / Q000166:cytology; D005260:Female; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D010949:Plasma / Q000378:metabolism; D017713:Platelet Transfusion; D013997:Time Factors