24/06/2026
1. Massive Transfusion Protocol (MTP)
MTP is a pre-established, empiric strategy used when a patient is actively bleeding out and you cannot wait for lab results.
How it works: Blood products are delivered in coolers using a fixed, predefined ratio—usually 1:1:1 (1 unit of Packed Red Blood Cells : 1 unit of Fresh Frozen Plasma : 1 unit of Platelets).
The Goal: To roughly mimic whole blood, rapidly restore volume, and proactively prevent the "triad of death" (hypothermia, acidosis, and coagulopathy) before the patient bleeds to death.
The Downside: Because it is a generic ratio, it can lead to over-transfusing certain products the patient doesn't actually need, which wastes scarce blood resources and increases the risk of complications like fluid overload or lung injury.
2. Targeted (Goal-Directed) Transfusion
Targeted transfusion uses rapid, real-time blood testing to guide exactly what you give the patient.
How it works: Doctors use standard labs or point-of-care viscoelastic testing (like TEG or ROTEM) to see exactly how the patient's blood is clotting. If the test shows the patient has enough platelets but is low on fibrinogen, the doctor will order only cryoprecipitate or fibrinogen concentrate.
The Goal: To correct specific clotting defects efficiently, minimize unnecessary transfusions, and reduce complications.
The Downside: It requires specialized equipment and takes time (usually 10 to 15 minutes for initial results)—time a massively bleeding patient might not have.
