A multiply-injured trauma patient receives a massive transfusion. The recommended ratio of packed red blood cells : fresh frozen plasma : platelets in current massive transfusion protocols (MTPs) based on PROPPR trial evidence is approximately:
- A 1:1:1 (balanced haemostatic resuscitation) ✓
- B 10:1:1 (predominant RBCs)
- C 1:2:2 (plasma and platelet dominant)
- D 2:1:1 (RBC dominant with moderate plasma)
Correct answer: A. 1:1:1 (balanced haemostatic resuscitation)
Explanation
The PROPPR trial (NEJM 2015) demonstrated that a 1:1:1 ratio of pRBC : FFP : platelets (one apheresis platelet per 6 units RBC equivalent) improved haemostasis, reduced 24-hour and 30-day mortality, and increased achievement of haemostasis compared to 1:1:2. This 'balanced' or 'damage control' haemostatic resuscitation strategy prevents dilutional coagulopathy by delivering coagulation factors early alongside red cells. Cryoprecipitate and TXA (tranexamic acid) are adjuncts per CRASH-2 trial.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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