A hospital activates a massive transfusion protocol (MTP) for an exsanguinating trauma patient. The evidence-based target ratio for red blood cells : fresh frozen plasma : platelets in damage-control resuscitation is:

• A 6 : 1 : 1
• B 4 : 2 : 1
• C 3 : 1 : 0 (no platelets until count <50,000)
• D 1 : 1 : 1 (or close to it) ✓

Explanation

The PROPPR trial (2015) demonstrated that a 1:1:1 ratio (PRBC:FFP:Platelets) significantly reduced 24-hour mortality and achieved better haemostasis compared to a 1:1:2 ratio in exsanguinating trauma patients. Damage-control resuscitation aims to simultaneously correct the coagulopathy of trauma, not merely replace red cell volume. Giving early FFP and platelets in roughly equal proportions to red cells reconstitutes whole blood and addresses consumption coagulopathy, dilutional coagulopathy, and direct factor loss.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.