title: Effects of a hospital-wide introduction of a massive transfusion protocol on blood product ratio and blood product waste.
abstract: BACKGROUND
  Massive transfusion protocols (MTPs) are increasingly used in the transfusion practice and are developed to provide the standardized and early delivery of blood products and procoagulant agents and to supply the transfusion of blood products in a well-balanced ratio.
  
  
  OBJECTIVE
  The aim of this study was to investigate the effect of a hospital-wide introduction of an MTP on blood product ratio and a waste of blood products.
  
  
  METHODS
  Retrospective analysis was performed to compare the transfusion practice in massive bleeding patients before and after the introduction of an MTP and between the use of an MTP and transfusion off-protocol. Massive bleeding was defined as an administration of ≥5 units of red blood cells (RBCs) within 12 h.
  
  
  RESULTS
  Of 547 massively transfused patients, 192 patients were included in the pre-MTP period and 355 patients in the MTP period. The ratio of RBC to fresh frozen plasma (FFP) and the platelets transfused shifted significantly toward 1:1:1 in the MTP period (P = 0.012). This was mainly caused by a shift in RBC: FFP ratio (P = 0.014). An increase in the waste of blood products was observed, most notably FFPs (P = 0.026). Extending the storage time after thawing reduced the waste of FFPs from 11% to 4%.
  
  
  CONCLUSIONS
  Hospital-wide introduction of an MTP is an adequate way to achieve a well-balanced transfusion ratio of 1:1:1. This comes at the cost of an increase in the waste of FFPs, which is lowered after extending the duration of storage time after thawing.
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Bijlmer, Amsterdam, The Netherlands ; Department of Intensive Care Medicine, Academic Medical Center, Bijlmer, Amsterdam, The Netherlands.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Balvers
authors.affiliation: Department of Vascular Medicine, Academic Medical Center, Bijlmer, Amsterdam, The Netherlands.
authors.forename: Michiel
authors.initials: M
authors.lastname: Coppens
authors.affiliation: Clinical Research Unit, Academic Medical Center, Bijlmer, Amsterdam, The Netherlands.
authors.forename: Susan
authors.initials: S
authors.lastname: van Dieren
authors.affiliation: Laboratory of Hematology, Academic Medical Center, Bijlmer, Amsterdam, The Netherlands.
authors.forename: Ingeborg H M
authors.initials: IH
authors.lastname: van Rooyen-Schreurs
authors.affiliation: Laboratory of Clinical Chemistry, Academic Medical Center, Bijlmer, Amsterdam, The Netherlands.
authors.forename: Henriëtte J
authors.initials: HJ
authors.lastname: Klinkspoor
authors.affiliation: Clinical Research Unit, Academic Medical Center, Bijlmer, Amsterdam, The Netherlands ; Department of Immunopathology, Sanquin Research, Academic Medical Center, Bijlmer, Amsterdam, The Netherlands.
authors.forename: Sacha S
authors.initials: SS
authors.lastname: Zeerleder
authors.affiliation: Department of Anesthesiology, Academic Medical Center, Bijlmer, Amsterdam, The Netherlands.
authors.forename: Holger M
authors.initials: HM
authors.lastname: Baumann
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Bijlmer, Amsterdam, The Netherlands.
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, Bijlmer, Amsterdam, The Netherlands.
authors.forename: Nicole P
authors.initials: NP
authors.lastname: Juffermans
keywords: Bleeding; protocol; transfusion