In a patient with massive hemorrhage requiring massive transfusion protocol (MTP), the current evidence-based ratio for packed red blood cells (pRBCs), fresh frozen plasma (FFP), and platelets is:

• A 1:1:1 (pRBCs:FFP:platelets) ✓
• B 10:1:1 (pRBCs:FFP:platelets)
• C 4:1:1 (pRBCs:FFP:platelets)
• D 2:2:1 (pRBCs:FFP:platelets)

Explanation

The PROPPR trial (2015) — a landmark RCT comparing 1:1:1 vs 1:1:2 (pRBC:FFP:platelets) in massive hemorrhage — demonstrated that the 1:1:1 ratio achieved hemostasis more effectively, reduced 24-hour mortality, and lowered 30-day mortality compared to 1:1:2. The 1:1:1 ratio (approximating whole blood) is now the standard of care in MTP activation, reflecting the damage control resuscitation principle of avoiding crystalloid hemodilution-induced coagulopathy.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.