title: A national common massive transfusion protocol (MTP) is a feasible and advantageous option for centralized blood services and hospitals.
abstract: BACKGROUND
  A common national MTP was jointly implemented in 2011 by the national blood service (Blood Services Group) and seven participating acute hospitals to provide rapid access to transfusion support for massively haemorrhaging patients treated in all acute care hospitals.
  
  
  METHODS
  Through a systematic clinical workflow, blood components are transfused in a ratio of 1:1:1 (pRBC: whole blood-derived platelets: FFP), together with cryoprecipitate for fibrinogen replacement. The composition of components for the MTP is fixed, although operational aspects of the MTP can be adapted by individual hospitals to suit local hospital workflow. The MTP could be activated in support of any patient with critical bleeding and at risk of massive transfusion, including trauma and non-trauma general medical, surgical and obstetric patients.
  
  
  RESULTS
  There were 434 activations of the MTP from October 2011 to October 2013. Thirty-nine per cent were for trauma patients, and 30% were for surgical patients with heavy intra-operative bleeding, with 25% and 6% for patients with gastrointestinal bleeding and peri-partum haemorrhage, respectively. Several hospitals reported reduction in mean time between request and arrival of blood. Mean transfusion ratio achieved was one red cell unit: 0·8 FFP units: 0·8 whole blood-derived platelet units: 0·4 units of cryoprecipitate. Although cryoprecipitate usage more than doubled after introduction of MTP, there was no significant rise in overall red cells, platelet and FFP usage following implementation.
  
  
  CONCLUSIONS
  This successful collaboration shows that shared transfusion protocols are feasible and potentially advantageous for hospitals sharing a central blood provider.
authors.affiliation: Blood Services Group, Health Sciences Authority, Singapore City, Singapore.
authors.forename: J
authors.initials: J
authors.lastname: Chay
authors.affiliation: Blood Services Group, Health Sciences Authority, Singapore City, Singapore.
authors.forename: M
authors.initials: M
authors.lastname: Koh
authors.affiliation: Blood Services Group, Health Sciences Authority, Singapore City, Singapore.
authors.forename: H H
authors.initials: HH
authors.lastname: Tan
authors.affiliation: Department of Surgery, Singapore General Hospital, Singapore City, Singapore.
authors.forename: J
authors.initials: J
authors.lastname: Ng
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore City, Singapore.
authors.forename: H J
authors.initials: HJ
authors.lastname: Ng
authors.affiliation: Department of Anaesthesiology, Khoo Teck Puat Hospital, Singapore City, Singapore.
authors.forename: N
authors.initials: N
authors.lastname: Chia
authors.affiliation: Department of Haematology, Tan Tock Seng Hospital, Singapore City, Singapore.
authors.forename: P
authors.initials: P
authors.lastname: Kuperan
authors.affiliation: Department of Anaesthesiology, Tan Tock Seng Hospital, Singapore City, Singapore.
authors.forename: J
authors.initials: J
authors.lastname: Tan
authors.affiliation: Department of Anaesthesiology, KK Woman's & Children's Hospital, Singapore City, Singapore.
authors.forename: E
authors.initials: E
authors.lastname: Lew
authors.affiliation: Department of Haematology, National University Hospital, Singapore City, Singapore.
authors.forename: L K
authors.initials: LK
authors.lastname: Tan
authors.affiliation: Paediatrics, National University Hospital, Singapore City, Singapore.
authors.forename: P L
authors.initials: PL
authors.lastname: Koh
authors.affiliation: Department of Anaesthesiology, Changi General Hospital, Singapore City, Singapore.
authors.forename: K A
authors.initials: KA
authors.lastname: Desouza
authors.affiliation: Department of Anaethesiology, Jurong Health Services, Singapore City, Singapore.
authors.forename: S
authors.initials: S
authors.lastname: Bin Mohd Fathil
authors.affiliation: Blood Services Group, Health Sciences Authority, Singapore City, Singapore.
authors.forename: P M
authors.initials: PM
authors.lastname: Kyaw
authors.affiliation: Blood Services Group, Health Sciences Authority, Singapore City, Singapore.
authors.forename: A L
authors.initials: AL
authors.lastname: Ang
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000379:methods* / Q000592:standards; D002985:Clinical Protocols; D006470:Hemorrhage / Q000453:epidemiology / Q000628:therapy; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D017410:Practice Guidelines as Topic; D012846:Singapore; D065227:Transfusion Reaction
keywords: blood components; massive transfusion; plasma; platelet transfusion; transfusion - trauma