In a patient requiring massive blood transfusion (>10 units pRBC in 24 hours), the current damage control resuscitation protocol recommends transfusing blood products in what ratio?

• A pRBC:FFP:platelets = 10:1:1
• B pRBC only, with FFP given only for a PT >1.5× normal
• C pRBC:FFP:platelets = 1:1:1 ✓
• D Crystalloid first, then blood products when Hb <7 g/dL

Explanation

Damage control resuscitation using a 1:1:1 ratio of packed red blood cells:fresh frozen plasma:platelets is the current standard for massive hemorrhage in trauma. This balanced approach approximates whole blood, avoids the dilutional coagulopathy caused by crystalloid- or pRBC-heavy resuscitation, and reduces transfusion-associated complications. The PROPPR trial confirmed that a 1:1:1 ratio improved 24-hour survival and achieved hemostasis more effectively than a 2:1:1 ratio.

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

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