1. RETROSPECTIVE ANALYSIS OF MASSIVE TRANSFUSION PRACTICE IN NON-TRAUMA RELATED HEMORRHAGIC SHOCK IN A TERTIARY CARE CENTRE
Dr. Gayathri.A.M, Dr.S.Sathyabhama, Dr.Debasish Gupta
Department of Transfusion Medicine, SCTIMST,Trivandrum

2. Transfusion support to loss of blood >150ml/min
MASSIVE TRANSFUSION
ADULT
Transfusion of ≥10 red blood cell (RBC) units, which approximates the total blood volume (TBV) of an average adult patient, within 24 hr
Transfusion of >4 RBC units in 1hr with anticipation of continued need for blood product support
Replacement of >50% of the TBV by blood products within 3 hr
Transfusion support to loss of blood >150ml/min
PAEDIATRICS
Transfusion of >100%
TBV within 24 hr
Transfusion support to replace ongoing haemorrhage of >10% TBV /min
Replacement of >50%
TBV by blood products
within 3 hr

3. MAXIMUM SURGICAL BLOOD ORDER SCHEDULE (MSBOS) DESIGNED FOR OUR INSTITUTE
NEUROSURGERY CASES
CARDIOTHORACIC CASES
CASES
RBC REQUIREMENT
SCHWANNOMA 2
MENINGIOMA
ANEURYSM
AV MALFORMATION
HEMATOMA EVACUATION
CASES
RBC REQUIREMENT
CABG 2
AORTIC DISSECTION 4
AORTIC ANEURYSM
AV MALFORMATION
HEMATOMA EVACUATION
VALVULAR REPAIRS
SEPTAL DEFECTS, TOF, TAPVC, PDA
INTRA CARDIAC REPAIRS
CABG + VALVULAR REPAIR

4. MASSIVE TRANSFUSION PROTOCOL OF OUR INSTITUTE
5- 15 Kg BODY WEIGHT
< 5 Kg BODY WEIGHT
PACK
RBC
FFP
PLT
CRYO 1
1 (Paed)
NIL 2
1 (P) 3 4
1/2
PACK
RBC
FFP
PLT
CRYO 1
2 (Paed)
NIL 2
2 (P) 3 4
15-40 Kg BODY WEIGHT
>40 Kg BODY WEIGHT
PACK
RBC
FFP
PLT
CRYO 1 2
NIL 3 4
PACK
RBC
FFP
PLT
CRYO 1 4
NIL 2 3 6

5. AIMS & OBJECTIVES MATERIALS AND METHODS
To analyse retrospectively the massive transfusion practices and resultant outcome of patients over a period of two years
MATERIALS AND METHODS
This is a retrospective observational study of all patients who received a massive transfusion for non-traumatic hemorrhagic shock over a two-year period ( )
The primary outcome was in-patient hospital survival
Electronic medical records of 53 non-traumatic patients including both adult and paediatric cases that were admitted and had massive transfusion were assessed

6. Variables include : Age Sex Body weight Co-morbidities Drug history
Diagnosis and nature of surgical procedure
Pre-surgical laboratory investigations (Hb, PCV, platelet counts, PT/INR, aPTT, potassium, BUN) & post surgical laboratory parameters
Ratio of blood components transfused
Period of ICU, Ventilator, Extra- corporeal membrane oxygenator and hospital stay
Recovery index

7. TOTAL CASES SINCE 2 YEARS
RESULTS
2800
TOTAL CASES SINCE 2 YEARS
1450
TOTAL CASES: 6750
0.78%
GENDER SCORE
PAEDS
ADULTS
CARDIO
NEURO
MALE
11.3%
1.8%
32.2%
20.7%
FEMALE
3.9%
20.8%
7.5%

8. DIAGNOSIS
PROCEDURE

9. PRE- SURGICAL DRUG INTAKE
ASSOCIATED
CO-MORBIDITIES
PRE- SURGICAL DRUG INTAKE

10. DISTRIBUTION OF WEIGHT IN ALL CASES
DURATION OF HOSPITAL STAY, ICU STAY & VENTILLATOR STAY
NO. OF PATIENTS
ECMO
No. of cases
MALE 2
FEMALE 1

11. INTRA & POST OPERATIVE BLOOD USAGE
ADULT
PAEDIATRIC

12. PRE & POST SURGICAL INVESTIGATION COMPARISON
p value
0.07
0.6
0.04
0.014
<0.001
15.9
3.83
2.01
1.6
26.13
2.28
31.07
38.32
10.6
13.1

13. OUTCOME FOLLOWING MASSIVE TRANSFUSION
MORTALITY
EXPIRED %
NEUROSURGERY 2
14.28%
CARDIOTHORACIC SURGERY 12
85.72%
PATIENTS
OUTCOME
SURVIVORS (39)
73.58%
EXPIRED (14)
26.42%

14. CARDIOTHORACIC SURGERY (n=12)
Post op cardiac tamponade
(3 cases)
Poor preoperative anticoagulation management and multiple comorbidities (6 cases)
On table: Acute uncontrolled bleed in ruptured TAAA (2 cases)
CKD on Dialysis (1 case)
Ruptured multiple Intra cranial Aneurysm
NEUROSURGERY (n=2)
MORTALITY ANALYSIS

15. Statistically insignificant
OBSERVATIONS
All paediatric cases survived after appropriate massive transfusion protocol
Potassium and BUN in all scenarios
Hb, PCV, Platelet counts, PT & APTT in expired cases
Statistically insignificant

16. CONCLUSION
A good massive transfusion protocol is required to increase the patient survival rates
Good orchestration between clinicians, anaesthesiologist and blood center team
Appropriate utilisation of blood units
Turn around time should be reduced

17. LIMITATIONS TEG reporting were insufficient to do analysis
Baseline D-Dimer investigation not performed

18. REFERENCES
Kevin M S, Kimberly A D, Felix Y L et al. The status of massive transfusion protocols in United States trauma centers: massive transfusion or massive confusion? Transfusion 2010;50:
Norgaard A, Stensballe J, de Lichtenberg T H,et al. Three-year follow-up of implementation of evidence-based transfusion practice in a tertiary hospital. Vox Sang. 2017;112:
Shahram P, Hosseinali K, Golnar S, et al. Comparison of the impact of applications of Targeted Transfusion Protocol and Massive Transfusion Protocol in trauma patients. Korean J Anesthesiol 2017; 70:
Keyvan K, Rachel O, Terrence M Y, et al. Prediction of massive blood transfusion in cardiac surgery. CAN J ANESTH 2006 ;53:781–94
Zoe K M, Gemma C, Susan B, et al. Optimal Dose, Timing and Ratio of Blood Products in Massive Transfusion: Results from a Systematic Review. Transfus Med Rev. 2018;32(1):6-15

19. THANK YOU