title: Blood component transfusion and wastage rates in the setting of massive transfusion in three regional trauma centers.
abstract: The purpose of massive transfusion protocols (MTPs) is to provide large quantities of blood products rapidly to exsanguinating patients. The expected rates of blood product transfusion and wastage in this setting have not been defined. This study was undertaken to assess the transfusion and wastage rates for bleeding patients requiring emergency issue of blood components at three American Level I trauma centers.
  
  
  
  Three hospitals participated, all of which are Level I trauma centers that have MTPs in place where uncrossmatched red blood cells (RBCs) can be ordered with or without platelets (PLTs), plasma, and cryoprecipitate. Data on the transfusion, return to blood bank, and wastage rates were recorded on all products issued within 3 hours after MTP activation.
  
  
  
  The majority of products were issued to the emergency department and/or operating room at all three institutions (84%-95%). The percentage of RBCs, plasma, and PLTs transfused during MTPs were 39% to 65%, 43% to 66%, and 75% to 100%, respectively. Wastage rates were comparable for RBCs (0%-9%), plasma (0%-7%), and PLTs (0%-7%). Cryoprecipitate had the highest wastage rates at all three sites (7%-33%).
  
  
  
  A large portion of blood products issued during MTPs are not transfused. Some are wasted due to stringent storage requirements and/or limited shelf lives. The optimum ratio of transfused to returned products in these patients is likely to be determined more by clinical need than by transfusion service policy.
authors: Department of Pathology and Laboratory Medicine, the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.|Department of Medicine, and the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors: Nancy M
authors: NM
authors: Dunbar
authors: Department of Pathology and Laboratory Medicine, the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors: Nicholas J
authors: NJ
authors: Olson
authors: Department of Pathology and Laboratory Medicine, the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.|Department of Medicine, and the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors: Zbigniew M
authors: ZM
authors: Szczepiorkowski
authors: Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors: Eric D
authors: ED
authors: Martin
authors: The Institute for Transfusion Medicine.
authors: Ryan M
authors: RM
authors: Tysarcyk
authors: The Institute for Transfusion Medicine.|Department of Pathology, and the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Darrell J
authors: DJ
authors: Triulzi
authors: Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Louis H
authors: LH
authors: Alarcon
authors: The Institute for Transfusion Medicine.|Department of Pathology, and the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Mark H
authors: MH
authors: Yazer
mesh_terms: D001771:Blood Banks; D016913:Blood Component Transfusion; D005260:Female; D006801:Humans; D008297:Male; D014193:Trauma Centers