title: The development and implementation of, and first years' experience with, a massive/emergency transfusion protocol (damage control hematology protocol) in a Veterans Affairs hospital.
abstract: Published reports of massive or emergency transfusion protocols (MTP/ETPs) focus primarily on large trauma centers. There is little guidance available in the literature to assist nontrauma, hospital-based blood banks in the development of an MTP/ETP for occasional bleeding emergencies. Here, we describe the design of an MTP/ETP at the Veterans Affairs Connecticut Healthcare System in West Haven. The MTP/ETP consists of a protocolized distribution of red blood cells (RBCs), fresh frozen plasma (FFP) and platelets (PLTs), with cryoprecipitate and recombinant factor VIIa also available. In the first year of operation, the MTP/ETP was activated five times on five separate patients. All of the MTP/ETP patients received RBCs, FFP, and PLTs. Two out of five patients received cryoprecipitate. None of the patients received recombinant factor VIIa. Four of the five patients who underwent MTP/ETP survived at least 21 days following the event. A total of 2 units of FFP and 4 units of RBCs issued as a part of the MTP/ETP were wasted. The development of an MTP/ETP at our Veterans Affairs hospital helped to ensure that patients requiring massive transfusion received RBCs, FFP, and PLTs in a protocolized fashion as part of their resuscitation with relatively little product wastage.
authors.affiliation: Pathology and Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven Veterans Affairs Hospital, 950 Campbell Avenue, West Haven, CT 06516.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Gehrie
authors.affiliation: Pathology and Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven Veterans Affairs Hospital, 950 Campbell Avenue, West Haven, CT 06516.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Tormey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001771:Blood Banks / Q000458:organization & administration; D001788:Blood Grouping and Crossmatching / Q000379:methods; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000379:methods* / Q000706:statistics & numerical data; D054869:Clinical Audit; D002985:Clinical Protocols; D003237:Connecticut; D004630:Emergencies; D017707:Erythrocyte Transfusion / Q000379:methods; D005169:Factor VIII / Q000627:therapeutic use; D015942:Factor VIIa / Q000627:therapeutic use; D005340:Fibrinogen / Q000627:therapeutic use; D006396:Hematemesis / Q000628:therapy; D006787:Hospitals, Veterans / Q000458:organization & administration; D006801:Humans; D007755:Laboratories, Hospital / Q000458:organization & administration; D008297:Male; D010951:Plasma Exchange / Q000379:methods; D017713:Platelet Transfusion / Q000379:methods; D019106:Postoperative Hemorrhage / Q000628:therapy; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen; D015942:Factor VIIa