Massive Transfusion Protocol (MTP)

The New Zealand Blood Service (NZBS) has encouraged District Health Boards to develop protocols to enable the more efficient management of massive and acute bleeding.
It is difficult to give exact criteria which should lead to activating the MTP. Acute blood loss of 1 litre or more with signs of hypovolaemic shock such as tachycardia and hypotension, particularly if the cause of bleeding cannot be immediately controlled, would be the sort of situation to initiate the MTP.
An MTP should include a schedule that integrates the rapid provision of red cells, coagulation factors, and platelets, with the appropriate blood tests required to monitor the patient’s progress. In addition, tranexamic acid 1 g IV stat followed by an IV infusion of 1 g over 8 hours is indicated for bleeding associated with massive trauma (the CRASH-2 trial), but must be given as soon as possible and definitely within 3 hours of injury. Tranexamic acid may be helpful in other causes of massive bleeding (seek Consultant advice).
The CDHB has developed its own MTP (search for "mtp" at http://cdhb.health.nz). It can be activated by contacting the Blood Bank, tel 80310.
In other DHBs, contact your local Blood Bank/ NZBS to access the local MTP.

Reference: CRASH-2 Trial. Lancet.2010: 376(9734): 23-32.


Information about this CDHB document (17980):
Document Owner:	Blue Book Editorial Committee (see Who's Who)
Issue Date:	December 2013
Next Review:	December 2015
Keywords:	massive bleeding, bleeding, major haemorrhage
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document.
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Topic Code: 17980