A patient undergoing emergency aortic surgery has received 12 units of packed red blood cells in 30 minutes. A massive transfusion protocol (MTP) is activated. What is the current recommended ratio of blood components in damage control resuscitation?
- A 6 pRBC : 1 FFP : 1 platelet pool
- B 4 pRBC : 2 FFP : 0 platelets until platelet count <50,000
- C 1 pRBC : 1 FFP : 1 platelet pool (approximately 1:1:1 ratio) ✓
- D 2 pRBC : 1 FFP : 1 platelet pool
Correct answer: C. 1 pRBC : 1 FFP : 1 platelet pool (approximately 1:1:1 ratio)
Explanation
The PROPPR trial (2015) and subsequent evidence established that a balanced 1:1:1 ratio of pRBC:FFP:platelet pool most closely recreates whole blood composition, reduces coagulopathy of trauma, and improves 24-hour haemostasis and survival in massive haemorrhage. This approach — also called haemostatic resuscitation or damage control resuscitation — prevents dilutional and consumptive coagulopathy. Empiric ratios skewed toward pRBC without adequate coagulation factors lead to the lethal triad of hypothermia, acidosis, and coagulopathy.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.