Massive Transfusion Protocol (MTP) in Adults

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Questions and Answers

A trauma patient who received 8 units of PRBCs in 8 hours is actively bleeding and has an SBP of 95, HR of 125, and altered mental status. Which criterion is met to activate a massive transfusion protocol (MTP)?

The patient exhibits severe shock with an SBP <90, HR >120, and altered mental status. (correct)
The patient has received at least 10 units of PRBCs in 24 hours.
The patient's heart rate exceeds 100 bpm.
The patient has received at least 3-4 units of PRBCs in 4 hours.

A patient in the ICU is undergoing massive transfusion. Lab results reveal a fibrinogen level of 90 mg/dL. According to established guidelines, which blood product should be administered?

Cryoprecipitate (correct)
Platelets
Packed Red Blood Cells (PRBCs)
Fresh Frozen Plasma (FFP)

A patient undergoing massive transfusion develops prolonged QT intervals on their ECG. Which complication is most likely occurring, and what is the appropriate intervention?

Hypocalcemia; administer IV calcium. (correct)
Acidosis; administer bicarbonate.
Hypothermia; use blood warmers.
Hyperkalemia; administer insulin/D50.

During a massive transfusion, a patient develops respiratory distress and pulmonary edema. Which of the following complications is most likely occurring, and what is an appropriate nursing intervention?

<p>Volume overload; administer diuretics. (C)</p> Signup and view all the answers

A female trauma patient of childbearing age requires emergency blood transfusion before her blood type is determined. Which type of blood product is most appropriate to administer, and why?

<p>Type O Negative; it avoids potential Rh sensitization. (D)</p> Signup and view all the answers

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Flashcards

MTP Activation Criteria

≥ 10 units PRBCs in 24 hrs, ≥ 3-4 units in 1 hr, or ongoing uncontrolled hemorrhage with severe shock (SBP < 90, HR > 120, altered mental status).

Blood Product Ratio in MTP

Packed Red Blood Cells (PRBCs), Fresh Frozen Plasma (FFP), and Platelets, typically in a 1:1:1 or 2:1:1 ratio.

Cryoprecipitate Use

Replaces fibrinogen, Factor VIII, vWF, and Factor XIII to help clot formation in severe bleeding.

MTP Complication Prevention

Blood warmers, maintain product ratios, IV Calcium, monitor ECG, optimize perfusion, Strict I&Os.

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Nursing Priorities in MTP

Large-bore IVs, strict I&Os, continuous VS monitoring, assess transfusion reactions, coordinate with blood bank.

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Study Notes

Outlines the criteria for activating a Massive Transfusion Protocol (MTP), blood product ratios during MTP, use of cryoprecipitate and tranexamic acid (TXA), potential complications and their prevention, and nursing priorities in managing blood product transfusions.

MTP Activation Criteria

Hemoglobin levels for men should be 13.8–17.2 g/dL and for women, 12.1–15.1 g/dL.
Initiate MTP if a patient receives ≥ 10 units of Packed Red Blood Cells (PRBCs) in 24 hours or ≥ 3-4 units in 1 hour.
Ongoing uncontrolled hemorrhage due to trauma, GI bleed, OB hemorrhage, or surgery warrants MTP activation.
Severe shock, indicated by SBP < 90, HR > 120, and altered mental status, necessitates MTP.

Blood Product Ratio

Balanced ratios such as 1:1:1 or 2:1:1 of blood products are crucial.
Blood products include PRBCs, Fresh Frozen Plasma (FFP), and platelets.
FFP provides coagulation factors.
Platelets prevent thrombocytopenia.
Cryoprecipitate is administered if fibrinogen levels drop below 100-150 mg/dL.
Emergency blood is Type O (Rh-negative for women of childbearing age, Rh-positive for others), switch to type-specific blood as soon as possible.

Cryoprecipitate & TXA

Cryoprecipitate replaces fibrinogen, Factor VIII, von Willebrand Factor (vWF), and Factor XIII.
Cryoprecipitate is essential for clot formation in severe bleeding.
Administer cryoprecipitate when fibrinogen levels are < 100-150 mg/dL or < 1 g/L.
Consider TXA (Tranexamic Acid) for patients in shock or with severe sepsis, especially if PT/INR > 1.5 of aPTT >40.

Complications & Prevention

Hypothermia can be prevented by using blood warmers.
Dilutional coagulopathy is managed by maintaining appropriate blood product ratios.
Hypocalcemia (citrate toxicity) can be treated by administering IV calcium, monitor QT interval.
Monitor ECG for hyperkalemia, consider administering calcium, insulin/D50.
Optimize perfusion and consider bicarbonate for acidosis.
Monitor for pulmonary edema and consider diuretics to prevent volume overload.

Nursing Priorities

Use large-bore IVs or a central line for rapid transfusion.
Strictly monitor intake and output to prevent overload or shock.
Continuously monitor vital signs, including BP, HR, SpO2, and temperature.
Assess for transfusion reactions such as fever, hemolysis, Transfusion-Related Acute Lung Injury (TRALI), and anaphylaxis.
Coordinate with the blood bank, ICU team, and pharmacy.

Step-by-Step ICU Blood Product Management

Determine if the patient meets transfusion criteria, check hemoglobin levels, assess for active bleeding or liver disease which may indicate the need for FFP to supply clotting factors or low platelet levels.

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Description

Learn about the Massive Transfusion Protocol (MTP) for managing severe hemorrhage in adults. Includes MTP activation criteria based on hemoglobin levels, units of blood received, and signs of severe shock. Covers blood product ratios (PRBCs, FFP, platelets), use of cryoprecipitate and TXA, potential complications, and nursing priorities.