Lancaster General Hospital’s updated Massive Transfusion Protocol (MTP) and new Rapid Release Protocol aim to provide the best possible clinical outcomes while reducing waste of blood products.
Susan M. Bator, M.D., Medical Director of the LGH Blood Bank, said the new protocols are designed to improve clinical outcomes while reducing waste.
Susan M. Bator, M.D., Medical Director of the LGH Blood Bank, said the MTP ensures that blood and blood products are immediately available to patients who clinically exhibit massive blood loss, most often in cases of trauma, a GI bleed or aneurysm.
An attending physician can call an MTP, which occurs about two or three times per month at LGH, she said.
Patients with known or suspected massive or exsanguinating hemorrhage must meet two of these criteria: systolic blood pressure of less than 90mmHg, heart rate greater than 120 beats per minute, clinical evidence of penetrating torso trauma and positive focused ultrasound assessment for trauma.
The existing protocol calls for releasing 6 units of packed red blood cells (PRBC) and 4 units of fresh frozen plasma (FFP). Now, when an MTP is called, 6 units each of PRBC and FFP, and 1 pooled unit of platelets will be released in a 1:1:1 ratio.
Trauma research associates this ratio with better clinical outcomes, Dr. Bator said. However, the new protocol requires enough platelets to be available at all times to support an MTP, in addition to other patients’ needs, which could present a challenge given their short shelf life.
“Platelets are a very hard inventory to control, because they’re only good for five days,” she said. “That makes it very challenging to collect from volunteer donors and to keep enough in inventory.”
As an alternative, a new Rapid Release Protocol can be used for patients who have an immediate need for greater than 2 units of blood but do not meet the MTP criteria. These patients will have prepared 4 units of PRBC and 1 unit of FFP – a smaller amount of FFP and no platelets.
In these cases, the Blood Bank will provide the best product available at the time, based on what is known about the patient, Dr. Bator said. This may include blood products that are not cross-matched. Rapid Release gives providers access to “immediate” blood, no matter what stage of compatibility testing is completed.
“Sometimes physicians call an MTP just because they need blood quickly,” she said. “They don’t realize we can get O blood to them rapidly. This rapid release protocol gives them an alternative.”
Overall, the LGH Blood Bank both collects and uses less blood than in the past – about 600 units per month -- with very little waste, Dr. Bator said. FFP, which expires in 24 hours once thawed, is the biggest source of waste. When possible, the Blood Bank now uses a new plasma product (thawed plasma) that keeps for five days, which helps to reduce waste.
Providers will receive additional education on both new protocols, which are not yet finalized.
Related Blood Bank news
Nancy Dillow, BSN, RN, is the current Transfusion Safety Specialist for LG Health. She worked as a staff nurse in the Main PACU for the past 8 ½ years and recently as an Adjunct Clinical Instructor for the PA College of Health Sciences. She came to LGH with an extensive background in adult and pediatric critical care. Her focuses will include blood product utilization and blood administration safety, and our Patient Blood Management Program.
The LGH Blood Bank will update donor criteria to reflect recent changes to FDA recommendations. To reduce the risk of HIV transmission, the FDA previously recommended against allowing men who have had sex with men to donate blood. The FDA now recommends a 12-month deferral period for these donors.
LGH is updating its policy regarding consent for blood transfusions in non-emergent situations. Consent must be obtained and signed by both the patient and physician. The policy is being updated to meet a requirement of The Joint Commission.